中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (12): 806-809.doi: 10.3969/j.issn.1671-4091.2018.12.004

• 临床研究 • 上一篇    下一篇

腹膜透析治疗22 例新生儿急性肾损伤的疗效分析

杨杰1,肖菲1,陈佳1,万静芳1, 蔡明玉1, 龚文姜1,余艳1, 何娅妮1   

  1. 1. 陆军军医大学大坪医院野战外科研究所肾内科
  • 收稿日期:2018-07-23 修回日期:2018-08-07 出版日期:2018-12-12 发布日期:2018-12-19
  • 通讯作者: 何娅妮 heynmail@yahoo.com E-mail:heynmail@yahoo.com

A therapeutic analysis of the effectiveness of peritoneal dialysis in 22 neonatal babies with acute kidney injury

  • Received:2018-07-23 Revised:2018-08-07 Online:2018-12-12 Published:2018-12-19

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摘要： 【摘要】目的分析急诊腹膜透析治疗急性肾损伤(acute kidney injury，AKI)新生儿的临床预后及并发症。方法回顾性分析陆军军医大学大坪医院新生儿重症监护室(intensive care unit,ICU)接受急诊腹膜透析治疗的22 例AKI 患儿的Apgar 评分，AKI 分期、合并多器官功能衰竭数目、是否使用血管活性药物及机械通气、腹膜透析治疗的剂量及时间、并发症、30 天存活率等。疗效指标包括：肾功能、电解质、乳酸水平等，并使用Cox 回归模型分析影响存活率的因素。结果纳入分析的22 例患儿中男性12例，女性10 例，平均胎龄(34.95±4.34)周，体质量为(2.44±0.92)kg，出生Apgar 评分为(7.32±3.05)分，AKI1 期患儿占13.64%(3/22)，AKI2 期患儿占22.73%(5/22)，AKI3 期患儿占63.64%(14/22)。导致AKI的原发疾病为新生儿肺炎9 例，脓毒血症6 例，宫内窒息4 例，其他3 例。合并多器官功能衰竭的占
77.27% (17/22)，其中2 个器官衰竭占27.27% (6/22)，3 个及以上器官衰竭占50.0% (11/22)，需机械通气占72.73% (16/22)，使用血管活性药物比例为68.18% (15/22)。腹膜透析治疗时间平均为（154.00±103.76）h，治疗剂量为（388.71±28.48）ml/(kg•d)。22 例患儿中存活9 例，死亡13 例，30 天存活率为40.9%(9/22)。Cox 回归模型分析显示：AKI3 期、使用血管活性药物、机械通气及3 个以上器官衰竭是患儿存活的影响因素。多因素回归分析显示：使用血管活性药物是显著影响患儿预后的独立危险因素。腹膜透析相关并发症的发生包括：透析液泄漏2 例，出口部位出血2 例，网膜阻塞导管3 例，无腹膜透析相关性腹膜炎发生。结论急诊腹膜透析治疗新生儿急性肾损伤是安全有效的，预后主要与患儿的全身基础情况相关。

关键词: 腹膜透析, 急性肾损伤, 新生儿, 疗效

Abstract: 【Abstract】Aim To analyze the clinical outcome and complication of emergent peritoneal dialysis (PD) in neonatal babies with acute kidney injury (AKI). Method This was a retrospective and cohort study. AKI neonatal babies treated with PD in the ICU, Department of Daping Hospital, Amy Medical University were analyzed. Apgar score, clinical stage of AKI, organs involved in multiple organ failure, vasoactive drugs, mechanical ventilation, dose, frequency and complications of PD, and 30～day survival rate in these babies were recruited. The indices of therapeutic effectiveness included renal function, electrolyte levels and lactate levels. Cox regression model was used to analyze the factors affecting survival rate. Results A total of 22 AKI newborns (12 males and 10 females) were enrolled in this study. Their average gestational age was (34.95±4.34) weeks, average weight was (2.44±0.92) kg, and Apgar score at birth was (7.32±3.05). Three neonatal babies (13.64%) had AKI at stage I, 5 babies (22.73%) at stage II, and 14 babies (63.64%) at stage III. The primary disease for AKI included neonatal pneumonia (9 cases), sepsis (6 cases), intrauterine asphyxia (4 cases) and other diseases (3 cases). Seventeen of them (77.27%) had multiple organ failure, including failure of two organs in 6 cases (27.27%) and failure of 3 or more than 3 organs in 11 cases (50.0%). Mechanical ventilation was conducted in 16 cases (72.73%) and vasoactive agents were used in 15 cases (68.18%). The average duration of PD was (154±103.76)h and the average dose was (388.71±28.48)ml/(kg· d). Nine cases survived and 13 cases died with the 30-day survival rate of 40.9%. Cox regression model analyses revealed that the key factors affecting the survival rate were AKI stage III, use of vasoactive drugs, mechanical ventilation and failure of more than 3 organs. Multivariate regression analyses showed that the use of vasoactive agents was an independent risk factor for prognosis. The PD related complications included leakage of dialysate (2 cases), exitsite bleeding (2 cases) and obstruction of the catheters due to omental wrap (3 cases). No PD associated peritonitis occurred. Conclusions Emergent PD was a safe and effective treatment for AKI in newborns. The prognosis of these neonatal babies depended mainly on their general conditions.

Key words: Peritoneal dialysis, Acute kidney injury, Neonatal, Therapeutic effectiveness