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目的分析腹膜透析在治疗新生儿急性肾功能衰竭中存在的问题、原因及处理方法,以提高抢救成功率。方法选择2003—2009年我院新生儿重症监护病房收治、经腹膜透析治疗的新生儿急性肾功能衰竭患儿,对其临床特点、腹膜透析治疗方法、合并症及预后等进行回顾性分析。结果研究期间共收治急性肾功能衰竭新生儿67例,其中8例进行腹膜透析治疗。8例患儿均出现不同程度的精神反应差、呕吐、水肿、无尿、电解质紊乱、糖代谢紊乱及代谢性酸中毒。肾功能恢复正常5例,好转1例,未恢复2例,其中因混合型休克死亡1例,因肾萎缩、肾功能进行性恶化放弃治疗死亡1例。透析过程中合并腹膜炎3例,其中2例原发病系感染性休克。8例患儿发生不同程度的低蛋白血症,贫血7例,造瘘口渗液5例,因渗液严重需再次置管3例。结论腹膜透析是治疗新生儿急性肾功能衰竭安全有效的方法。
Objective To analyze the problems, causes and treatment of peritoneal dialysis in the treatment of neonatal acute renal failure to improve the success rate of rescue. Methods A retrospective analysis was performed on the clinical features, peritoneal dialysis treatment, complications and prognosis in neonates with acute renal failure who were treated in our neonatal intensive care unit during 2003-2009. Results During the study, 67 newborns with acute renal failure were treated, and 8 of them were treated with peritoneal dialysis. All 8 patients showed different degrees of poor mental response, vomiting, edema, anuria, electrolyte imbalance, glucose metabolism disorder and metabolic acidosis. Renal function returned to normal in 5 cases, improved in 1 case, no recovery in 2 cases, of which 1 died of mixed shock, due to renal atrophy, progressive deterioration of renal function to give up treatment of death in 1 case. Dialysis in the process of peritonitis in 3 cases, of which 2 cases of primary disease septic shock. 8 cases of children with varying degrees of hypoproteinemia, anemia in 7 cases, fistula exudate in 5 cases, due to severe exudate need to re-catheterization in 3 cases. Conclusion Peritoneal dialysis is a safe and effective method for the treatment of neonatal acute renal failure.