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目的探讨腹膜透析改良装置用于治疗复杂重症婴幼儿心脏病术后急性肾功能不全的效果,并观察患儿术后早期血流动力学的影响。方法心脏直视术后发生急性肾功能不全复杂重症心脏病婴幼儿24例,依据就诊时间分为2组,2009年10月―2010年10月9例(对照组)术后应用传统腹膜透析装置进行腹膜透析,2010年11月―2013年7月15例(改良组)应用改良腹膜透析装置进行透析,比较2组腹膜透析治疗时间、呼吸机辅助时间、ICU住院时间,观察腹膜透析治疗前、后血钙、血钾、尿素氮、血肌酐水平变化。结果改良组腹膜透析时间、呼吸机辅助时间、ICU住院时间分别为(195.73±6.20)h、(142.40±5.65)h、(9.74±1.07)d,对照组分别为(237.60±5.75)h、(185.27±6.45)h、(12.17±1.56)d,2组以上指标比较差异均有统计学意义(P<0.05);经腹膜透析后,对照组6例、改良组11例尿量恢复正常,高血钾、低血钙得到纠正,尿素氮、肌酐恢复正常;对照组3例死于严重低心排出量综合征,改良组死于严重低心排出量综合征、多器官功能衰竭各2例。结论采用改良腹膜透析装置进行腹膜透析可有效治疗复杂重症婴幼儿心脏直视术后发生的急性肾功能不全,与传统透析装置比较,在纠正钾、钙电解质紊乱等方面更具优势。
Objective To investigate the effect of modified peritoneal dialysis device on acute renal insufficiency in patients with complicated severe infantile heart disease and to observe the effect of early postoperative hemodynamics. Methods Twenty-four infants and young children with acute renal insufficiency complicated with severe heart disease underwent open heart surgery were divided into two groups according to the treatment time. From October 2009 to October 2010, 9 patients (control group) were treated with conventional peritoneal dialysis device Peritoneal dialysis was performed. From November 2010 to July 2013, 15 cases (modified group) were treated with modified peritoneal dialysis device. Dialysis treatment time, ventilator support time and hospital stay time were compared between the two groups. Before peritoneal dialysis treatment, After calcium, potassium, urea nitrogen, serum creatinine levels. Results The peritoneal dialysis time, ventilator - assisted time and ICU stay in the modified group were (195.73 ± 6.20) h and (142.4 ± 5.65) h and (9.74 ± 1.07) d, respectively, while those in the control group were (237.60 ± 5.75) and 185.27 ± 6.45) h, (12.17 ± 1.56) d respectively. There were significant differences between the two groups (P <0.05). After peritoneal dialysis, the urine volume of 6 cases in the control group and 11 cases in the modified group returned to normal, Blood potassium and hypocalcemia were corrected, and urea nitrogen and creatinine returned to normal. In the control group, 3 patients died of severe low cardiac output syndrome. In the improved group, severe low cardiac output syndrome and 2 multiple organ failure occurred. Conclusions Peritoneal dialysis with modified peritoneal dialysis device can effectively treat acute renal insufficiency after open heart surgery in children with complicated severe infants. Compared with traditional dialysis devices, it is more advantageous in correcting potassium and calcium electrolyte imbalance.