腹膜透析治疗小儿先天性心脏病术后急性肾功能不全的临床疗效.docVIP

精品论文 参考文献 腹膜透析治疗小儿先天性心脏病术后急性肾功能不全的临床疗效 汪 蓉 刘正清 杨宝义 郭学珍 湖北医药学院附属太和医院重症医学科 湖北十堰 442000 　　【摘 要】目的：探讨腹膜透析治疗小儿先天性心脏病术后急性肾功能不全的临床疗效。方法：对我科2011年1月-2013年1月收治的30例先天性心脏病术后急性肾功能不全患儿，均行腹膜透析治疗。结果：治愈25例，3例死于多器官功能衰竭，2例死于低心排血量综合征。25例患儿经腹膜透析治疗后，水、电解质及酸碱均平衡，低氧血症及低心排血量综合征均被纠正，心肝肾功能明显改善。结论：腹膜透析是治疗小儿先天性心脏病术后急性肾功能不全的有效方法，值得临床推广。 　　【关键词】腹膜透析；急性肾功能不全；心脏手术 　　【中图分类号】R726.5 【文献标识码】B 【文章编号】1674-8999（2015）6-0201-01 　　The curative effect observation of peritoneal dialysis for acute renal failure after surgery for congenital heart disease in infants 　　Wang rong，Liu Zhengqing. 　　(Intensive Care Unit,Taihe Hospital Affiliated to Hubei Medical College,shiyan,442000) 　　【Abstract】Objective：To observe the curative effect of peritoneal dialysis for acute renal failure after surgery for congenital heart disease in infants。Methods：From January 2011 to January 2013 30 cases of acute renal failure after surgery for congenital heart disease patients in our department were treated with peritoneal dialysis。Results：Among the 30 patients，25 patients were cured，5 patients died，among them 3 patients died of multiple organ failure，2 patients died of low cardiac output syndrome。After 25 patients were treated with peritoneal dialysis，water，electrolytes and acid-base were balanced，hypoxemia and low cardiac output syndrome have been corrected，heart，liver and kidney function were improved significantly。Conclusions：peritoneal dialysis is an effective treatment on acute renal failure after surgery for congenital heart disease in infants，warranting an extensive use clinically。 　　【Key words】peritoneal dialysis；acute renal failure；cardiac surgery 　　自2011年1月至2013年1月对30例先天性心脏病术后急性肾功能不全患儿施行腹膜透析，为评价其临床疗效，现报告如下 　　1 资料和方法 　　1.1 临床资料：本组30例，男18例，女12例。年龄6月－2岁，平均1.3岁。室间隔缺损15例，法洛四联症8例，法洛三联症5例，心内膜垫缺损2例，心功能分级（NYHA）Ⅰ级12例，Ⅱ级8例，Ⅲ级8例，Ⅳ级2例。 所有患儿均在低温体外循环下行根治术。 　　1.2 腹膜透析方法：取脐旁右侧腹直肌小切口，根据测量距离将Tenckhoff透析管紧贴腹壁顺耻骨联合置入盆腔最低位，于腹膜上荷包固定透析管，依次缝合腹外斜肌腱膜、皮下及皮肤，于皮肤上再次固定透析管。腹膜透析指征：（1）术后尿量逐渐减少，静脉用利尿剂无效，连续4h尿量lt;0.5ml/（kg*h）；(2)血肌酐值gt;200umol/L或超