Flynn J T, Kershaw D B, Smoyer W E, Brophy P D, McBryde K D, Bunchman T E
Division of Pediatric Nephrology, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, USA.
Perit Dial Int. 2001 Jul-Aug;21(4):390-4.
While the use of continuous renal replacement therapies in the management of children with acute renal failure (ARF) has increased, the role of peritoneal dialysis (PD) in the treatment of pediatric ARF has received less attention.
Retrospective database review of children requiring PD for ARF over a 10-year period.
Pediatric intensive care unit at a tertiary-care referral center.
Sixty-three children without previously known underlying renal disease who required PD for treatment of ARF.
Causes of ARF were congestive heart failure (27), hemolytic-uremic syndrome (13), sepsis (10), nonrenal organ transplant (7), malignancy (3), and other (3). Mean duration of PD was 11 +/- 13 days. Children with ARF were younger (30 +/- 48 months vs 88 +/- 68 months old, p < 0.0001) and smaller (11.9 +/- 15.9 kg vs 28 +/- 22 kg, p < 0.0001) than children with known underlying renal disease who began PD during the same time period. Percutaneously placed PD catheters were used in 62% of children with ARF, compared to 4% of children with known renal disease (p < 0.0001). Hypotension was common in patients with ARF (46%), which correlated with a high frequency of vasopressor use (78%) at the time of initiation of PD. Complications of PD occurred in 25% of patients, the most common being catheter malfunction. Recovery of renal function occurred in 38% of patients; patient survival was 51%.
Peritoneal dialysis remains an appropriate therapy for pediatric ARF from many causes, even in severely ill children requiring vasopressor support. Such children can be cared for without the use of more expensive and technology-dependent forms of renal replacement therapies.
虽然连续性肾脏替代疗法在急性肾衰竭（ARF）患儿管理中的应用有所增加，但腹膜透析（PD）在小儿ARF治疗中的作用却较少受到关注。
对10年间因ARF需要进行PD治疗的患儿进行回顾性数据库分析。
一家三级医疗转诊中心的儿科重症监护病房。
63名既往无已知潜在肾脏疾病且因ARF需要进行PD治疗的患儿。
ARF的病因包括充血性心力衰竭（27例）、溶血尿毒综合征（13例）、脓毒症（10例）、非肾脏器官移植（7例）、恶性肿瘤（3例）及其他（3例）。PD的平均持续时间为11±13天。与同期开始进行PD治疗的已知潜在肾脏疾病患儿相比，ARF患儿年龄更小（30±48个月对88±68个月，p<0.0001）且体重更轻（11.9±15.9 kg对28±22 kg，p<0.0001）。62%的ARF患儿使用了经皮置入的PD导管，而已知肾脏疾病患儿这一比例为4%（p<0.0001）。低血压在ARF患者中很常见（46%），这与开始PD治疗时血管升压药的高使用率（78%）相关。25%的患者发生了PD并发症，最常见的是导管故障。38%的患者肾功能恢复；患者生存率为51%。
腹膜透析仍然是多种病因所致小儿ARF的一种合适治疗方法，即使是需要血管升压药支持的重症患儿。这类患儿无需使用更昂贵且依赖技术的肾脏替代疗法即可得到治疗。
