Nephrology Department, Amato Lusitano Hospital, Castelo Branco, Portugal.
Perit Dial Int. 2012 May-Jun;32(3):273-9. doi: 10.3747/pdi.2009.00239. Epub 2011 May 31.
Acute kidney injury (AKI) is a common complication in children after surgery for congenital heart disease, and peritoneal dialysis (PD) is usually the renal replacement therapy (RRT) of choice, especially in very young children. The aim of the present study was to describe our experience of using PD to treat AKI after cardiac surgery. We retrospectively analyzed children 1 week to 16 years of age undergoing cardiac surgery during 2000-2008 and found the incidence of AKI treated with PD to be 2.3%. In the 23 patients treated with PD (13 male; average age: 29 ± 48.4 months; weight: 9.1 ± 8.1 kg), the indications for PD initiation were oliguria (n = 13), anuria (n = 9), and acidosis (n = 1). The average time between cardiac surgery and AKI was 4.8 ± 16.8 hours, and between AKI and PD initiation, it was 12 ± 16.8 hours. Patients were treated for a mean of 4.8 ± 3.8 days. Two patients developed peritonitis, and mechanical dysfunction of the PD catheter occurred in 1 patient. In-hospital mortality was 43.4%. Patients treated with PD weighed less (p = 0.004) and had longer bypass time (p = 0.004), inotrope use (p = 0.000), and mechanical ventilation (p = 0.000). However, in a regression analysis, only cardiopulmonary bypass time (odds ratio: 1.021; 95% confidence interval: 0.998 to 1.027; p = 0.032) remained predictive of a subsequent need for PD. We conclude that PD is an efficacious RRT for AKI in children undergoing cardiac surgery and that, in this setting, bypass time is the strongest predictor of a subsequent need for RRT.
急性肾损伤（AKI）是儿童先天性心脏病手术后的常见并发症，腹膜透析（PD）通常是首选的肾脏替代治疗（RRT），尤其是在非常年幼的儿童中。本研究的目的是描述我们使用 PD 治疗心脏手术后 AKI 的经验。我们回顾性分析了 2000-2008 年期间接受心脏手术的 1 周至 16 岁的儿童，发现 PD 治疗 AKI 的发生率为 2.3%。在接受 PD 治疗的 23 例患者（13 例男性；平均年龄：29 ± 48.4 个月；体重：9.1 ± 8.1kg）中，开始 PD 的指征为少尿（n = 13）、无尿（n = 9）和酸中毒（n = 1）。心脏手术后至 AKI 的平均时间为 4.8 ± 16.8 小时，AKI 至 PD 开始的平均时间为 12 ± 16.8 小时。患者平均接受治疗 4.8 ± 3.8 天。2 例患者发生腹膜炎，1 例患者 PD 导管发生机械功能障碍。院内死亡率为 43.4%。接受 PD 治疗的患者体重较轻（p = 0.004），体外循环时间较长（p = 0.004）、使用正性肌力药物（p = 0.000）和机械通气时间较长（p = 0.000）。然而，在回归分析中，只有体外循环时间（比值比：1.021；95%置信区间：0.998 至 1.027；p = 0.032）仍然是随后需要 PD 的预测因素。我们得出结论，PD 是心脏手术后儿童 AKI 的有效 RRT，在这种情况下，体外循环时间是随后需要 RRT 的最强预测因素。
