CAJ | 학술논문

目的探讨腹膜透析治疗早产儿急性肾功能衰竭(acute renal failure,ARF)的有效性和安全性. 方法 2012年3月至201 5年3月,在广东省妇幼保健院新生儿重症监护病房住院的ARF早产儿中,12例进行腹膜透析.采用连续性腹膜透析的方法,透析液不加入抗生素.比较透析前后血清尿素氮、肌酐、血钾和pH的变化.观察堵管、渗漏、感染、新生儿坏死性小肠结肠炎等并发症情况,以及胃肠内营养建立情况.透析前后指标比较采用配对设计资料的Wilcoxon符号秩和检验. 结果 12例ARF早产儿中,9例为败血症,2例为窒息,1例为双胎输血综合征.12例患儿的平均出生胎龄为(30.9±3.2)周,透析前体重为(1 461±525)g,持续透析天数为(3.8±2.6)d.3例出现置管处渗漏.2例发生腹膜炎,腹水培养分别为白色念珠菌和肺炎克雷伯菌感染.6例患儿于腹膜透析结束后1～4 d建立胃肠内营养,其中1例喂养7d后出现坏死性小肠结肠炎.共有4例患儿治愈出院,6例因家属放弃治疗后死亡,2例因原发病严重而死亡.12例患儿透析前与透析后血尿素氮平均值分别为(12.71±6.98)与(9.16±3.15) mmol/L,血钾分别为(6.24±1.72)与(4.36±0.82) mmol/L,pH分别为7.21±0.17与7.32±0.17;透析后血尿素氮和血钾水平降低,pH值升高,差异均有统计学意义(Z值分别为-2.118、-2.197和-2.981,P值均＜0.05).结论腹膜透析治疗早产儿ARF安全有效,且操作及所需设备较为简单,可用于肾脏替代治疗.
목적 탐토복막투석치료조산인급성신공능쇠갈(acute renal failure,ARF)적유효성화안전성. 방법 2012년3월지201 5년3월,재광동성부유보건원신생인중증감호병방주원적ARF조산인중,12례진행복막투석.채용련속성복막투석적방법,투석액불가입항생소.비교투석전후혈청뇨소담、기항、혈갑화pH적변화.관찰도관、삼루、감염、신생인배사성소장결장염등병발증정황,이급위장내영양건립정황.투석전후지표비교채용배대설계자료적Wilcoxon부호질화검험. 결과 12례ARF조산인중,9례위패혈증,2례위질식,1례위쌍태수혈종합정.12례환인적평균출생태령위(30.9±3.2)주,투석전체중위(1 461±525)g,지속투석천수위(3.8±2.6)d.3례출현치관처삼루.2례발생복막염,복수배양분별위백색념주균화폐염극뢰백균감염.6례환인우복막투석결속후1～4 d건립위장내영양,기중1례위양7d후출현배사성소장결장염.공유4례환인치유출원,6례인가속방기치료후사망,2례인원발병엄중이사망.12례환인투석전여투석후혈뇨소담평균치분별위(12.71±6.98)여(9.16±3.15) mmol/L,혈갑분별위(6.24±1.72)여(4.36±0.82) mmol/L,pH분별위7.21±0.17여7.32±0.17;투석후혈뇨소담화혈갑수평강저,pH치승고,차이균유통계학의의(Z치분별위-2.118、-2.197화-2.981,P치균＜0.05).결론 복막투석치료조산인ARF안전유효,차조작급소수설비교위간단,가용우신장체대치료.
Objective To investigate the effectiveness and safety of peritoneal dialysis(PD) in premature infants with acute renal failure(ARF).Methods In the neonatal intensive care unit (NICU) of Guangdong Province Maternal and Children Hospital, 12 premature infants underwent continuous PD due to ARF from March 2012 to March 2015, without using any antibiotics in the dialysis fluid.Before and after dialysis, the changes of serum urea nitrogen, creatinine, potassium and pH were compared.The complications (blockage, leakage, infection and necrotizing enterocolitis) and gastrointestinal nutrition situation were observed.Wilcoxon signed rank sum test was used for statistical analysis.Results Among the 12 premature infants, the underlying causes of ARF were sepsis (n=9), perinatal asphyxia (n=2), twin twin transfusion syndrome (n=l).The average gestational age was (30.9±3.2) weeks, the average body weight (before PD) was (1 461 ±525) g, the duration of PD was (3.8±2.6) d.Complications associated with PD included leakage (n=3) and peritonitis (n=2) in which Candids albicans and Klebsiella pneumonia were identified in ascites.Gastrointestinal nutrition was built up in six cases within one to four days after dialysis, among which one developing necrotizing enterocolitis on the 7th d after feeding.Finally, eight babies died (six died after initiative discontinued treatment and two died because of critically illness) and four patients were cured and discharged.Lower serum urea nitrogen and potassium levels and higher pH value were shown after dialysis than before [(9.16 ± 3.15) vs (12.71 ±6.98) mmol/L;(4.36±0.82) vs (6.24± 1.72) mmol/L;7.32±0.17 vs 7.21 ±0.17;Z=-2.118,-2.197 and-2.981, all P ＜ 0.05).Conclusion PD is an alternative safe and effective treatment for premature infants with ARF due to its simplicity both in manipulation and equipment requirement.