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连续性肾脏替代治疗在新生儿急性肾损伤救治中的应用

Application of continuous renal replacement therapy in treatment of neonatal acute kidney injury
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摘要 目的观察连续性肾脏替代治疗(CRRT)在新生儿急性肾损伤(AKI)救治中的效果。方法回顾性分析2012年6月至2017年6月上海交通大学附属儿童医院新生儿重症监护病房(NICU)开展CRRT技术救治住院治疗的17例危重症新生儿的临床资料,其中AKI 15例,收集并分析该15例AKI新生儿的临床资料。15例AKI患儿均在常规治疗基础上进行CRRT,CRRT模式为连续性静-静脉血液滤过透析(CVVHDF)13例,血浆置换(PE)2例。分析CRRT治疗前、治疗12 h、治疗24 h、治疗48 h及治疗结束时患儿的血压(BP)、肾功能、电解质、酸碱平衡指标及血流动力学指标的变化,评价CRRT在新生儿AKI救治中的效果。结果15例AKI新生儿出生胎龄33^+4~40^+1周,入院日龄2~28 d,出生体质量2.25~4.00 kg;原发疾病依次为出生时重度窒息6例,新生儿脓毒症5例,先天性遗传代谢病2例,创伤性窒息、肝衰竭各1例;15例AKI患儿转流时间为49~190 h;CRRT治疗12 h BP[(50.8±6.57) mmHg(1 mmHg=0.133 kPa)]可达正常水平;CRRT治疗12 h血pH值(7.31±0.25)明显上升,CRRT治疗12 h血钾离子(K+)[(5.51±1.86) mmol/L]、尿素氮(BUN)[(9.5±3.7) mmol/L]、肌酐(Cr)[(93±14)μmol/L]明显下降,24 h达正常范围[K^+(4.78±2.95) mmol/L,BUN(7.5±2.1) mmol/L,Cr(54±13) μmol/L],治疗24 h尿量[(0.8±0.2) mL/(kg·h)]出现增多,动脉血氧分压[pa(O2)]/吸入氧体积分数(FiO2)治疗12 h达到200 mmHg,24 h>300 mmHg。CRRT治疗15例新生儿AKI均显示有效。结论CRRT能有效改善新生儿AKI的内环境,降低新生儿AKI的病死率,可为新生儿AKI救治提供一种有效的辅助治疗措施。 Objective To explore the efficacy of continuous renal replacement therapy (CRRT) in the treatment of neonatal acute kidney injury (AKI). Methods Totally 17 critically ill neonates treated with CRRT were selected who were hospitalized at Department of Neonatology, Shanghai Children′s Hospital, Children′s Hospital Affiliated to Shanghai Jiaotong University, from June 2012 to June 2017, and among them there were 15 cases with AKI, and the clinical data of these 15 patients were retrospectively analyzed, while 15 AKI neonates were treated with CRRT combined with conventional treatment.The model for CRRT was continuous veno-venous hemofiltration dialysis (CVVHDF) in 13 cases, plasma exchange (PE) in 2 cases.The changes of blood pressure(BP), renal function, electrolyte, acid-base balance index and hemodynamic indicators were analyzed respectively before CRRT treatment, 12 h, 24 h, 48 h after treatment and by the end of CRRT treatment.The efficacy of CRRT treatment was evaluated in these 15 AKI neonates. Results Gestational age of 15 AKI newborns was 33+ 4- 40+ 1 weeks, admission day age was 2-28 days, birth weight was 2.25-4.00 kg.Primary diseases were severe asphyxia in 6 cases, neonatal septicemia in 5 cases, congenital hereditary metabolic disease in 2 cases, traumatic asphyxia in 1 case, and liver failure in 1 case.CRRT treatment persisted for 49-190 hours.BP value[(50.8±6.57) mmHg(1 mmHg=0.133 kPa)] could reach normal level after 12 h CRRT treatment, and blood pH value (7.31±0.25) increased significantly after 12 h CRRT treatment, while blood K+ [(5.51±1.86) mmol/L], urea nitrogen (BUN)[(9.5±3.7) mmol/L], creatinine(Cr)[(93±14) μmol/L] significantly decreased after 12 h CRRT treatment, and reached the normal range[K^+ (4.78±2.95) mmol/L, BUN (7.5±2.1) mmol/L, Cr (54±13) μmol/L] after 24 h treatment, but urine volume[(0.8±0.2) mL/(kg·h)] significantly increased after 24 h treatment.Partial pressure of oxygen/fraction of inspired oxygen reached 200 mmHg after 12 h treatment and more than 300 mmHg af
作者 蔡成 裘刚 龚小慧 颜崇兵 沈云琳 洪文超 Cai Cheng;Qiu Gang;Gong Xiaohui;Yan Chongbing;Shen Yunlin;Hong Wenchao(Department of Neonatology,Shanghai Children's Hospital,Children's Hospital Affiliated to Shanghai Jiaotong University,Shanghai 200062,China)
机构地区 上海市儿童医院
出处 《中华实用儿科临床杂志》 CSCD 北大核心 2019年第1期30-33,共4页 Journal of Applied Clinical Pediatrics
关键词 连续性肾脏替代治疗 肾损伤 婴儿 新生 效果 安全性 Continuous renal replacement therapy Kidney injury Infant, newborn Efficacy Safety
作者简介 通信作者:裘刚,Email:qiugang214@163.com.
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