Hilt H, Goecke J, Gramm H J
Klinik für Anaesthesiologie und operative Intensivmedizin, Klinikum Steglitz der Freien Universität Berlin.
Anaesthesist. 1988 Sep;37(9):601-5.
Acute renal failure (ARF) in newborns and infants is a serious postoperative complication. Peritoneal dialysis is considered the treatment of choice, but is often impossible postoperatively. In adult patients or older children, continuous arteriovenous hemofiltration (CAVH) has been established for 10 years. In 1985, Ronco published case reports on four newborn infants treated with CAVH using a specially designed hemofilter. In between, a few more case reports have been published. We report a case of postoperative septic ARF in an 8-week-old girl with a body weight of 4000 g. We used the Minifilter (Amicon Corp.) connected to a femoral arterial Shaldon catheter and initially a central venous line, later a subclavian Shaldon catheter. Intermittent hemodialysis without ultrafiltration was performed as well. With ultrafiltration rates of 2 to 24 ml/h, mean 12.8 ml/h, we achieved an impressive loss of weight and the pulmonary function improved. The baby died on the 5th day of CAVH treatment of septic multiorgan failure. Even though the small patient did not survive, we demonstrated the feasibility of the method in newborns. CAVH is recommended for overhydrated babies with oligoanuric ARF, but it is not sufficient as a substitute for dialysis in these patients.
新生儿和婴儿急性肾衰竭（ARF）是一种严重的术后并发症。腹膜透析被认为是首选治疗方法，但术后往往无法进行。在成年患者或大龄儿童中，持续动静脉血液滤过（CAVH）已经应用了10年。1985年，龙科发表了关于4例使用特殊设计的血液滤过器进行CAVH治疗的新生儿病例报告。在此期间，又发表了一些病例报告。我们报告了1例体重4000g的8周龄女孩术后感染性ARF病例。我们使用了与股动脉Shaldon导管相连的小型滤器（密理博公司），最初连接中心静脉导管，后来连接锁骨下Shaldon导管。还进行了无超滤的间歇性血液透析。超滤率为2至24ml/h，平均12.8ml/h，体重明显减轻，肺功能得到改善。婴儿在CAVH治疗感染性多器官功能衰竭的第5天死亡。尽管这个小患者没有存活下来，但我们证明了该方法在新生儿中的可行性。对于有少尿性ARF的水过多婴儿，推荐使用CAVH，但它不足以替代这些患者的透析治疗。
