Pina Joseph S, Moghadam Soraya, Cushner Howard M, Beilman Greg J, McAlister Vivian C
United States Army Pacific, , Madigan Army Medical Center, Tacoma, Washington, USA.
J Trauma. 2010 May;68(5):1253-6. doi: 10.1097/TA.0b013e3181d99089.
Complications of renal failure may prevent timely evacuation of injured soldiers. Conventional renal replacement therapy is not available in forward surgical units.
Records of in-theater improvised peritoneal dialysis (IPD) in level III hospitals or forward surgical units in Iraq or Afghanistan were reviewed to determine the following: cause of renal failure and associated injuries; type of dialysate, peritoneal access, and exchange technique; and patient outcome. These data were used to propose method for IPD using commonly available materials.
IPD is described in four patients. Abdominal or chest drains were used with either improvised dextrose-electrolyte solution or commercial dialysate. Exchanges were successful, despite fresh surgical wounds including full laparotomy, removed excess fluid and restored acid and electrolyte balance, but did not correct azotemia. Open abdominal packing prevented continuation of IPD after 48 hours. Two patients fully recovered, one died, and one patient with a poor prognosis was lost to follow-up.
IPD can be delivered effectively using readily available materials in forward surgical units and level III combat support hospitals.
肾衰竭并发症可能会妨碍受伤士兵及时后送。前沿外科单位无法开展传统的肾脏替代治疗。
回顾了伊拉克或阿富汗三级医院或前沿外科单位中战地简易腹膜透析（IPD）的记录，以确定以下内容：肾衰竭病因及相关损伤；透析液类型、腹膜通路及交换技术；以及患者结局。这些数据被用于提出一种使用常用材料进行IPD的方法。
对4例患者进行了IPD治疗。腹部或胸部引流管与简易葡萄糖电解质溶液或市售透析液一起使用。尽管存在包括全腹切开术在内的新鲜手术伤口，但交换仍取得成功，排出了多余液体，恢复了酸碱及电解质平衡，但未纠正氮质血症。开放性腹腔填塞在48小时后导致IPD无法继续进行。2例患者完全康复，1例死亡，1例预后不良患者失访。
在前沿外科单位和三级战斗支援医院中，使用现成材料可有效开展IPD。
