Skippen P W, Krahn G E
Pediatric Critical Care, BC Children's Hospital, University of British Columbia, Canada.
Crit Care Resusc. 2005 Dec;7(4):286-91.
To investigate the incidence, implicating factors and outcome of acute renal failure after cardiopulmonary bypass in patients admitted to a paediatric intensive care unit.
Prospective observational pilot study.
A 14 bed paediatric intensive care unit in a university affiliated, tertiary care referral children's hospital.
One hundred and one children (less than sixteen years of age) admitted to the Pediatric Intensive Care Unit following cardiopulmonary bypass between June 2003 and May 2004.
None.
PRISM-III score was calculated on admission. Baseline admission urea (mmol/L) and creatinine (micromol/L) serum levels and highest urea and creatinine levels were measured. Urine output (mL/kg/hour) and frusemide dose (mg/kg/day) were also noted. A baseline inotrope score was calculated on admission and the highest inotrope score was noted based on maximum infused doses of inotrope in the first 36 hours. The surgical procedure was used to determine a Jenkins score. Eleven (11%) children developed acute renal injury (doubling of creatinine), one child (1%) developed acute renal failure (tripling of creatinine) and one child died (1%). No child required dialysis for acute renal failure and none developed chronic renal impairment. Low cardiac output was the only significant risk factor identified for developing acute renal injury or failure.
Acute renal injury is common and occurred in 11% of our children following congenital cardiac surgery, but acute renal failure requiring dialysis is uncommon.
调查入住儿科重症监护病房的患者体外循环术后急性肾衰竭的发生率、相关因素及转归。
前瞻性观察性试点研究。
一所大学附属医院的三级转诊儿童医院中设有14张床位的儿科重症监护病房。
2003年6月至2004年5月期间接受体外循环术后入住儿科重症监护病房的101名儿童（年龄小于16岁）。
无。
入院时计算PRISM-III评分。测定基线入院时尿素（mmol/L）和肌酐（micromol/L）血清水平以及最高尿素和肌酐水平。记录尿量（mL/kg/小时）和速尿剂量（mg/kg/天）。入院时计算基线血管活性药物评分，并根据前36小时血管活性药物的最大输注剂量记录最高血管活性药物评分。采用手术方式确定詹金斯评分。11名（11%）儿童发生急性肾损伤（肌酐翻倍），1名儿童（1%）发生急性肾衰竭（肌酐增至三倍），1名儿童死亡（1%）。无儿童因急性肾衰竭需要透析，也无儿童发生慢性肾功能损害。低心排血量是发生急性肾损伤或肾衰竭唯一确定的显著危险因素。
急性肾损伤常见，在我们的先天性心脏病手术后儿童中发生率为11%，但需要透析的急性肾衰竭并不常见。
