Matthews D E, West K W, Rescorla F J, Vane D W, Grosfeld J L, Wappner R S, Bergstein J, Andreoli S
Department of Surgery, Indiana University Medical Center, Indianapolis.
J Pediatr Surg. 1990 Jan;25(1):110-5; discussion 116. doi: 10.1016/s0022-3468(05)80174-5.
This report describes a 7-year experience with acute peritoneal dialysis in 31 neonates and infants less than 60 days of age. There were 20 boys and 11 girls, ages 3 to 60 days. Tenckhoff catheters of modified length were placed in the newborn intensive care unit (ICU), pediatric ICU, or surgery suites, and hourly exchanges (20 cc/kg) were started immediately postoperatively. Diagnoses included congenital metabolic disorders (11), acute tubular necrosis (6), postcardiopulmonary bypass with renal failure (5), renal cortical necrosis (5), obstructive uropathy (2), renal agenesis (1), and bilateral renal dysplasia (1). Complications included: peritonitis (4), bowel perforation (1), exit site infection (3), leaking dialysate (4), catheter obstruction (2), inguinal hernias (3), umbilical hernia (1), and retroperitoneal hemorrhage (1). There were 19 deaths (61.3%) from 1 to 90 days postinsertion in this high risk group. The (1), and post liver transplant (1). Effective dialysis (lowering of blood urea nitrogen (BUN) or ammonia, correction of acidosis, decrease in fluid overload) was possible in all cases. Five of the 12 survivors remain on chronic dialysis awaiting renal transplantation. Peritoneal dialysis is effective in the newborn period in the management of metabolic disturbances as well as renal failure. Morbidity and mortality (61.3%) is related to the near-morbid condition of the baby at the time of insertion and the severity of the complex underlying diagnosis often associated with multiorgan failure.
本报告描述了31例年龄小于60天的新生儿和婴儿进行急性腹膜透析的7年经验。其中男20例，女11例，年龄3至60天。将改良长度的Tenckhoff导管置于新生儿重症监护病房（ICU）、儿科ICU或手术室，术后立即开始每小时一次的交换（20 cc/kg）。诊断包括先天性代谢紊乱（11例）、急性肾小管坏死（6例）、体外循环后肾衰竭（5例）、肾皮质坏死（5例）、梗阻性尿路病（2例）、肾缺如（1例）和双侧肾发育不良（1例）。并发症包括：腹膜炎（4例）、肠穿孔（1例）、出口部位感染（3例）、透析液渗漏（4例）、导管阻塞（2例）、腹股沟疝（3例）、脐疝（1例）和腹膜后出血（1例）。在这个高危组中，插入导管后1至90天内有19例死亡（61.3%）。（此处原文似乎不完整），以及肝移植后（1例）。所有病例均能进行有效的透析（降低血尿素氮（BUN）或氨、纠正酸中毒、减轻液体超负荷）。12名幸存者中有5名仍在接受慢性透析，等待肾移植。腹膜透析在新生儿期对代谢紊乱以及肾衰竭的治疗是有效的。发病率和死亡率（61.3%）与插入导管时婴儿的近乎病态状况以及通常与多器官衰竭相关的复杂潜在诊断的严重程度有关。
