University of Mich Medical School, Ann Arbor, Mich, USA.
J Thorac Cardiovasc Surg. 2013 Aug;146(2):334-8. doi: 10.1016/j.jtcvs.2012.10.009. Epub 2012 Nov 8.
Children who undergo cardiac surgery are at high risk for renal insufficiency and abdominal compartment syndrome. Peritoneal dialysis catheter (PDC) implantation is used in this population for abdominal decompression and access for dialysis. However, there is no consensus regarding PDC use, and the practice varies widely. This study was undertaken to assess associated factors, outcomes, and variability in the use of PDC in patients who have undergone cardiac surgery.
The cohort was obtained from the Kids' Inpatient Database, years 2006 and 2009. Patients who underwent cardiac surgery were included and the subset that underwent PDC implantation during the same hospitalization was identified. Univariable and multivariable analyses assessed factors associated with PDC and survival.
A cohort of 28,259 patients underwent cardiac surgery, of whom 558 (2%) had PDCs placed. In the PDC group, 39.1% (n = 218) had acute renal failure whereas 3.5% or patients (n = 974) in the non-PDC group had acute renal failure. Among patients receiving PDC, mortality was 20.3% (n = 113; vs 3.4% overall mortality, n = 955). Excluding patients with acute renal failure, mortality remained 12% (n = 41) for the PDC group. Factors associated significantly with PDC placement in the overall cohort were younger age, greater surgical complexity, nonelective admission, hospital region, use of cardiopulmonary bypass, and acute renal failure.
Patients receiving PDC after cardiac surgery had 20% mortality, which remained 12% after excluding patients with acute renal failure. Given the variability in PDC use and poor outcomes, further research is needed to assess the possible benefit of earlier intervention for peritoneal access in this high-risk cohort.
接受心脏手术的儿童存在肾功能不全和腹腔间隔室综合征的高风险。在该人群中，腹膜透析导管（PDC）植入用于腹部减压和透析通路。然而，PDC 的使用没有共识，实践差异很大。本研究旨在评估接受心脏手术的患者中 PDC 使用的相关因素、结果和变异性。
该队列来自 2006 年和 2009 年的儿科住院患者数据库。纳入接受心脏手术的患者，并确定同一住院期间接受 PDC 植入的亚组。单变量和多变量分析评估了与 PDC 和生存相关的因素。
共 28259 例患者接受了心脏手术，其中 558 例（2%）放置了 PDC。在 PDC 组中，39.1%（n=218）发生急性肾衰竭，而非 PDC 组中 3.5%（n=974）的患者发生急性肾衰竭。在接受 PDC 的患者中，死亡率为 20.3%（n=113；而总死亡率为 3.4%，n=955）。排除急性肾衰竭患者后，PDC 组的死亡率仍为 12%（n=41）。在整个队列中，与 PDC 放置显著相关的因素包括年龄较小、手术复杂性较高、非选择性入院、医院所在地区、使用心肺旁路和急性肾衰竭。
接受心脏手术后接受 PDC 的患者死亡率为 20%，排除急性肾衰竭患者后死亡率仍为 12%。鉴于 PDC 使用的变异性和不良结局，需要进一步研究评估在这一高危人群中早期干预腹膜通路的可能益处。
