小儿心脏手术后腹膜透析:益处和风险

S. Saadé, N. Hanna, C. Mourani
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摘要

新生儿和接受先天性心脏病手术修复的婴儿有发生急性肾损伤(AKI)的风险。我们的目的是确定与AKI最相关的手术,比较腹膜透析(PD)和常规治疗的效果,并研究与PD死亡率相关的危险因素。材料和方法:回顾2016年11月至2017年12月接受心脏手术的儿童的记录。比较PD治疗与常规治疗的临床及生物学效果。在PD组中,将幸存者和非幸存者亚组进行比较,研究PD相关死亡率的危险因素。我们比较了早期和晚期PD(术后24小时以上)的死亡率。结果:研究期间共手术134例。27例(20%)发生AKI,其中9例(33%)接受PD治疗。动脉切换与AKI的相关性最高(71.4%)。PD治疗48h后肌酐和尿素氮(BUN)水平较常规治疗有较好的降低效果(肌酐:28.8±14.5 vs 7.5±12.1 μ mol/L, p=0.003) (BUN: 3.08±2.1 vs 0.91±1.5mmol/L, p=0.017)。PD组幸存者(n=5)在PD前6小时的平均动脉压高于非幸存者(n=4)(55.3±9.6 vs 40.0±3.6 mmHg, p=0.019)。幸存者PD后24小时pH值也较高(7.37±0.03 vs 7.31±0.02,p=0.014),肌酐变化较好(-3.6±5.8 vs 29.0±13.0微mol/L, p=0.02),利尿改善较好(4.4±3.2 vs 0.23±1.1ml/kg/h, p=0.039)。早期和晚期PD患者的死亡率没有差异。PD无重大并发症。结论:PD治疗心脏手术后AKI是安全的。对BUN和肌酐水平有较好的疗效。低心排血量、持续酸中毒和没有肌酐或利尿改善的PD死亡率较高。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Peritoneal dialysis after pediatric cardiac surgery: benefits and risks
Introduction: Neonates and infants having surgical repair for congenital heart disease are at risk of developing acute kidney injury (AKI). Our objectives were to determine surgeries most associated with AKI, to compare effect of peritoneal dialysis (PD) and conventional treatment, and to study the risk factors associated with PD mortality. Materials and methods: Records of Children who underwent cardiac surgery from November 2016 until December 2017 were reviewed. Clinical and biological effects of PD and conventional treatment were compared. In PD group, subgroups of survivors and non-survivors were compared to study risk factors for mortality associated with PD. We compared mortality between early and late PD (more than 24 hours after surgery). Results: 134 children were operated during the study period. 27 (20%) developed AKI and 9 of those (33%) received PD. Arterial switch was most associated with AKI (71.4%). PD had better effect in decreasing creatinine and blood urea nitrogen (BUN) levels after 48 hours treatment than conventional treatment (creatinine: 28.8±14.5 vs 7.5±12.1micromol/L, p=0.003) (BUN: 3.08±2.1 vs 0.91±1.5mmol/L, p=0.017). In PD group, survivors (n=5) had higher mean arterial pressure in the 6 hours prior to PD that non-survivors (n=4) (55.3±9.6 vs 40.0±3.6 mmHg, p=0.019). Survivors had also higher pH 24 hours after PD (7.37±0.03 vs 7.31±0.02, p=0.014), better creatinine variation (-3.6±5.8 vs 29.0±13.0micromol/L, p=0.02), and better diuresis improvement (4.4±3.2 vs 0.23±1.1ml/kg/h, p=0.039). There was no mortality difference between early and late PD. There were no major complications with PD. Conclusion: PD is safe for AKI after heart surgery. It has better outcome on BUN and creatinine levels. PD mortality is higher with low cardiac output, persistence of acidosis and absence of creatinine or diuresis improvement.
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