Nakamura K, Onitsuka T, Kuwahara M, Fukumoto K, Fukushima Y, Tomita Y, Shibata K, Koga Y
Second Department of Surgery, Miyazaki Medical College, Miyazaki, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1993 Aug;41(8):1316-22.
From 1982 to 1991, 13 (3.9%) of 336 children who underwent open heart surgery required peritoneal dialysis postoperatively, including 5 with transposition of the great arteries, 4 with tetralogy of Fallot, 2 with ventricular septal defect, 1 each with atrioventricular canal defects and total anomalous pulmonary venous connection. Patients ages ranged from 12 days to 4 years (mean, 1 year and 4 months). The infusion catheter was directed toward diaphragm from the right lower quadrant, and the drainage catheter was placed in the pelvis from the left upper quadrant. Dialysis solution was instilled and drained simultaneously. Seven children (54%) recovered renal function, with six (46%) longterm survivors. Differences between patients who did and did not recovered renal function (Group A and Group B respectively) were examined. No significant intergroup difference existed in age or weight. PD was initiated significantly sooner in Group B (1.2 +/- 0.8 days) than in Group A (3.2 +/- 1.9 days) (p < 0.05). The negative fluid balance was 88.0 +/- 31 mL/kg/day in Group A and 78.4 +/- 25.0 mL/kd/day (NS). BUN and serum creatinine concentrations were slightly elevated in both group, but were not significant different. Patients in Group A were dialyzed from 3 days to 21 days (mean 9.9 +/- 6.4 days), and patients in Group B were dialyzed from 1 day to 14 days (mean 5.3 +/- 5.2 days) (NS). The central venous pressure (CVP) in Group A decreased while blood pressure (BP) and renal perfusion pressure (RPP) increased following initiation of PD. CVP increased in Group B, while BP and RPP decreased. All patients died of low cardiac output syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)
1982年至1991年期间，336例接受心脏直视手术的儿童中有13例（3.9%）术后需要进行腹膜透析，其中5例为大动脉转位，4例为法洛四联症，2例为室间隔缺损，1例为房室管缺损，1例为完全性肺静脉异位连接。患者年龄从12天至4岁不等（平均为1岁4个月）。输注导管从右下腹指向膈肌，引流导管从左上腹置于盆腔。透析液同时进行灌注和引流。7名儿童（54%）肾功能恢复，6名（46%）为长期存活者。对肾功能恢复和未恢复的患者（分别为A组和B组）进行了差异检查。两组患者在年龄或体重方面无显著组间差异。B组开始腹膜透析的时间（1.2±0.8天）明显早于A组（3.2±1.9天）（p<0.05）。A组的负液体平衡为88.0±31 mL/kg/天，B组为78.4±25.0 mL/kg/天（无显著性差异）。两组的血尿素氮和血清肌酐浓度均略有升高，但无显著差异。A组患者腹膜透析3天至21天（平均9.9±6.4天），B组患者腹膜透析1天至14天（平均5.3±5.2天）（无显著性差异）。A组开始腹膜透析后中心静脉压（CVP）下降，而血压（BP）和肾灌注压（RPP）升高。B组CVP升高，而BP和RPP下降。所有患者均死于低心排血量综合征。（摘要截断于250字）
