Pang Yachang,Xu Zhuoming,Zhang Mingjie,et al.Application and effect of peritoneal dialysis in children after congenital heart surgery[J].Journal of Clinical Pediatric Surgery,2021,20(08):743-748.[doi:10.12260/lcxewkzz.2021.08.008]
腹膜透析在小儿先天性心脏病手术后的应用
- Title:
- Application and effect of peritoneal dialysis in children after congenital heart surgery
- Keywords:
- Heart Diseases/CN; Heart Defects; Congenital/SU; Peritoneal Dialysis; Treatment Outcome; Child
- 分类号:
- R541;R459.51;R726.1
- 摘要:
- 目的 探讨儿童先天性心脏病（congenital heart disease，CHD）手术后腹膜透析（peritoneal dialysis，PD）的危险因素及早期腹膜透析的应用指征及临床意义。方法 以2015年1月至2018年12月于上海儿童医学中心行心脏手术的12 922例CHD患者作为研究对象，其中679例术后进行了腹膜透析（PD组），12 243例未进行腹膜透析（NPD组），通过单因素及多因素分析探究PD的危险因素，进一步通过倾向性评分匹配后分析早期腹膜透析与延迟腹膜透析对预后的影响。结果 多因素Logistic回归分析显示：行姑息手术（OR=2.864，95%CI：2.082~3.938）、延迟关胸（OR=4.789，95%CI：3.611~6.353）、术前缺氧（OR=4.452，95%CI：3.571~5.551）、RACHs-1评分≥3分（OR=2.919，95%CI：2.337~3.646）、体外循环时间（CPB）≥120 min （OR=1.897，95%CI：1.441~2.498）、ACC≥60 min （OR=1.913，95%CI：1.457~2.511）及年龄较小（OR=1.011，95%CI：1.002~1.020）是先天性心脏病术后行腹膜透析的危险因素。倾向性评分匹配后发现，早期腹膜透析和延迟腹膜透析组病死率及腹膜透析持续时间差异无统计学意义（P>0.05），而呼吸机支持时间、CICU滞留时间及住院时间差异有统计学意义（P<0.05）。结论 姑息手术、延迟关胸、术前缺氧、RACHs-1评分≥3分、CPB≥120 min、ACC≥60 min及年龄是影响先天性心脏病手术后是否需行腹膜透析的危险因素。早期腹膜透析虽然对病死率及腹膜透析持续时间影响不大，但可以明显缩短呼吸机支持时间、CICU滞留时间及住院天数。
- Abstract:
- Objective To explore the risk factors for peritoneal dialysis after congenital heart surgery in children and discuss the indications and clinical significance of early peritoneal dialysis. Methods Clinical data were reviewed for 12, 922 children undergoing heart surgery from January 2015 to December 2018. For study group, 679 cases of peritoneal dialysis were recruited while another 12, 243 children without peritoneal dialysis selected as control group. The occurring risk factors of peritoneal dialysis were examined by single and multiple-factor analysis. And the prognosis was compared between early and delayed peritoneal dialysis. Results Palliative operation, delayed sterna closure, preoperative hypoxia, RACHS-1 ≥3, CPB ≥120 min, ACC ≥60 min and age had significant differences (P<0.05). While there was no difference of statistical significance of mortality between early and delayed PD group, hospital stay, ICU stay and mechanical support time were shorter in early PD group. Conclusion Palliative operation, delayed sternal closure, preoperative hypoxia, RACHS-1≥3, CPB≥120 min, ACC≥60 min and age are the occurring risk factors of PD after congenital heart surgery. Though without effect on mortality, early peritoneal dialysis can decrease the durations of hospital stay, ICU stay and mechanical support time.
参考文献/References:
1 Ueno K, Shiokawa N, Takahashi Y, et al. kidney disease:improving global outcomes in neonates with acute kidney injury after cardiac surgery[J]. Clin Exp Nephrol, 2020, 24(2):167-173. DOI:10.1007/s10157-019-01805-7.
2 杨宇齐, 袁立英, 陈爽, 等. 先天性心脏病患儿术后急性肾损伤相关因素分析[J]. 中华医学杂志, 2019, 99(22):1717-1721. DOI:10.3760/cma.j.issn.0376-2491.2019.22.00. Yang YQ, Yuan LY, Chen S, et al. Risk factors for acute kidney injury after pediatric congenital heart surgery[J]. Natl Med J China, 2019, 99(22):1717-1721. DOI:10.3760/cma.j.issn.0376-2491.2019.22.00.
3 Wang Y, Bellomo R.Cardiac surgery-associated acute kidney injury:risk factors, pathophysiology and treatment[J]. Nat Rev Nephrol, 2017, 13(11):697-711. DOI:10.1038/nrneph.2017.119.
4 敖翔.儿童腹膜透析的应用[J]. 临床肾脏病杂志, 2017, 17(3):132-135. DOI:10.3969/j.issn.1671-2390.2017.03.001. Ao X.Application of peritoneal dialysis in children[J]. J Clin Nephrol, 2017, 17(3):132-135. DOI:10.3969/j.issn.1671-2390.2017.03.001.
5 全雪丽, 王洁.腹膜透析在婴幼儿先天性心脏病手术后的应用[J]. 临床小儿外科杂志, 2018, 17 (10):795-798. DOI:10.3969/j.issn.1671-6353.2018.10.016. Quan XL, Wang J.Application of peritoneal dialysis for infants and toddlers after operations for congenital heart disease[J]. J Clin Ped Sur, 2018, 17(10):795-798. DOI:10.3969/j.issn.1671-6353.2018.10.016.
6 Kwiatkowski DM, Krawczeski CD.Acute kidney injury and fluid overload in infants and children after cardiac surgery[J]. Pediatr Nephrol, 2017, 32(9):1509-1517. DOI:10.1007/s00467-017-3643-2.
7 Chan KL, Ip P, Chiu CS, et al. Peritoneal dialysis after surgery for congenital heart disease in infants and young children[J]. Ann Thorac Surg, 2003, 76(5):1443-1449. DOI:10.1016/s0003-4975(03)01026-9.
8 Santos CR, Branco PQ, Gaspar A, et al. Use of peritoneal dialysis after surgery for congenital heart disease in children[J]. Perit Dial Int, 2012, 32(3):273-279. DOI:10.3747/pdi.2009.00239.
9 ?zker E, Sarita ? B, Vuran C, et al. Early initiation of peritoneal dialysis after arterial switch operations in newborn patients[J]. Ren Fail, 2013, 35(2):204-209. DOI:10.3109/0886022X.2012.745773.
10 Pan T, Li D, Li SJ, et al. Early initiation of peritoneal dialysis improves postoperative recovery in children with right ventricular outflow tract obstructive lesions at high risk of fluid overload:a propensity score-matched analysis[J]. Interact Cardiovasc Thorac Surg, 2018, 27(2):250-256. DOI:10.1093/icvts/ivy048.
11 Namachivayam SP, Butt W, Millar J, et al. Early Peritoneal dialysis and major adverse events after pediatric cardiac surgery:a propensity score analysis[J]. Pediatr Crit Care Med, 2019, 20(2):158-165. DOI:10.1097/PCC.0000000000001793.
12 Kwiatkowski DM, Menon S, Krawczeski CD, et al. Improved outcomes with peritoneal dialysis catheter placement after cardiopulmonary bypass in infants[J]. J Thorac Cardiovasc Surg, 2015, 149(1):230-236. DOI:10.1016/j.jtcvs.2013.11.040.
13 Hirano D, Ito A, Yamada A, et al. independent risk factors and 2-year outcomes of acute kidney injury after surgery for congenital heart disease[J]. Am J Nephrol, 2017, 46(3):204-209. DOI:10.1159/000480358.
14 Lee SH, Kim SJ, Kim HJ, et al. acute kidney injury following cardiopulmonary bypass in children-risk factors and outcomes[J]. Circ J, 2017, 81(10):1522-1527. DOI:10.1253/circj.CJ-17-0075.
15 Park SK, Hur M, Kim E, et al. Risk factors for acute kidney injury after congenital cardiac surgery in infants and children:a retrospective observational study[J]. PLoS One, 2016, 11(11):e0166328. DOI:10.1371/journal.pone.0166328.
16 Lee JH, Jung JY, Park SW, et al. Risk factors of acute kidney injury in children after cardiac surgery[J]. Acta Anaesthesiol Scand, 2018, 62(10):1374-1382. DOI:10.1111/aas.13210.
17 Bojan M, Gioanni S, Vouh, et al. Risk factors of acute kidney injury in children after cardiac surgery[J]. Acta Anaesthesiol Scandrospective Observational Study[J]. PLoS OneSurgd:a propensity score-matches[J]. Kidney Int, 2012, 82(4):474-481. DOI:10.1038/ki.2012.172.
18 Zarbock A, Kellum JA, Schmidt C, et al. Effect of early vs delayed initiation of renal replacement therapy on mortality in critically Ⅲ patients with acute kidney injury:The ELAIN Randomized Clinical Trial[J]. JAMA, 2016, 315(20):2190-2199. DOI:10.1001/jama.2016.5828.
19 Tu GW, Xu JR, Liu L, et al. Preemptive renal replacement therapy in post-cardiotomy cardiogenic shock patients:a historically controlled cohort study[J]. Ann Transl Med, 2019, 7(20):534. DOI:10.21037/atm.2019.09.140.
20 Yang XM, Tu GW, Gao J, et al. A comparison of preemptive versus standard renal replacement therapy for acute kidney injury after cardiac surgery[J]. J Surg Res, 2016, 204(1):205-212. DOI:10.1016/j.jss.2016.04.073.
相似文献/References:
[1]张泽伟,齐建川,高展,等.改良Carpentier法治疗Ebstein畸形[J].临床小儿外科杂志,2010,9(06):404.
ZHANG Ze wei,QI Jian chuan,GAO Zhan,et al.Modified Carpentier’s repair technique in the treatment of Ebstein’s Anomaly: a Clinical Analysis of 18 Cases.[J].Journal of Clinical Pediatric Surgery,2010,9(08):404.
[2]柏松,李晓峰,袁峰,等.单源化手术治疗肺动脉闭锁合并室间隔缺损及重要主肺动脉侧支血管[J].临床小儿外科杂志,2010,9(06):410.
BAI Song,LI Xiao feng,YUAN Feng,et al.Unifocalization repair for pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries.[J].Journal of Clinical Pediatric Surgery,2010,9(08):410.
[3]常绘文,沈振亚.右腋下小切口在儿童心内手术中的应用[J].临床小儿外科杂志,2010,9(06):439.
[4]丁晋阳 莫绪明 顾海涛 孙剑 彭卫 戚继荣 沈立 束亚琴 钱龙宝. 延迟关胸技术在婴儿复杂危重先心病手术中的应用[J].临床小儿外科杂志,2011,10(02):98.
DING Jin yang,MO Xu ming,GU Hai tao,et al. Delayed Sternal Closure following operations for complex and severe congenital heart disease in infant[J].Journal of Clinical Pediatric Surgery,2011,10(08):98.
[5]麻晓鹏,王涛,祖莹,等.肺动脉平滑肌细胞钙含量与先心病肺动脉高压的关联性研究[J].临床小儿外科杂志,2008,7(01):9.
[6]陈纲,贾兵,陈张根,等.儿童复杂先天性心脏病肺动脉环缩术后二期手术时机的探讨[J].临床小儿外科杂志,2008,7(02):10.
[7]宁岩松,乔彬,王同建,等.小婴儿先天性心脏病术后的呼吸管理[J].临床小儿外科杂志,2008,7(04):0.
[8]袁捷,谷兴琳,姜子菲,等.婴儿先天性心脏病非择期手术81例[J].临床小儿外科杂志,2008,7(04):0.
[9]谢学良,明腾,邹勇,等.209例体重5kg以下婴儿先天性心脏病的外科治疗及围术期处理[J].临床小儿外科杂志,2008,7(06):3.
[10]范庆浩,郑雪梅,黄国金,等.婴幼儿先天性心脏病手术治疗47例[J].临床小儿外科杂志,2007,6(03):15.
[11]陈纲,关吏,陈伟呈,等.先天性心脏病产前产后诊治一体化管理初步经验[J].临床小儿外科杂志,2021,20(06):525.[doi:10.12260/lcxewkzz.2021.06.005]
Chen Gang,Guan Li,Chen Weicheng,et al.Preliminary management experience of integrated congenital heart disease diagnosis and treatment during perinatal period[J].Journal of Clinical Pediatric Surgery,2021,20(08):525.[doi:10.12260/lcxewkzz.2021.06.005]
[12]孙鸣蔚,林茹.小儿先天性心脏病手术后出凝血管理的研究进展[J].临床小儿外科杂志,2021,20(06):550.[doi:10.12260/lcxewkzz.2021.06.009]
Sun Mingwei,Lin Ru.Research advances of postoperative coagulation management during pediatric cardiac surgery[J].Journal of Clinical Pediatric Surgery,2021,20(08):550.[doi:10.12260/lcxewkzz.2021.06.009]
备注/Memo
收稿日期:2020-03-09。
通讯作者:徐卓明,Email:zmxyfb@163.com