小儿心脏手术后腹膜透析:益处和风险

S. Saadé, N. Hanna, C. Mourani
{"title":"小儿心脏手术后腹膜透析:益处和风险","authors":"S. Saadé, N. Hanna, C. Mourani","doi":"10.15406/jpnc.2019.09.00396","DOIUrl":null,"url":null,"abstract":"Introduction: Neonates and infants having surgical repair for congenital heart disease are at risk of developing acute kidney injury (AKI). Our objectives were to determine surgeries most associated with AKI, to compare effect of peritoneal dialysis (PD) and conventional treatment, and to study the risk factors associated with PD mortality. Materials and methods: Records of Children who underwent cardiac surgery from November 2016 until December 2017 were reviewed. Clinical and biological effects of PD and conventional treatment were compared. In PD group, subgroups of survivors and non-survivors were compared to study risk factors for mortality associated with PD. We compared mortality between early and late PD (more than 24 hours after surgery). Results: 134 children were operated during the study period. 27 (20%) developed AKI and 9 of those (33%) received PD. Arterial switch was most associated with AKI (71.4%). PD had better effect in decreasing creatinine and blood urea nitrogen (BUN) levels after 48 hours treatment than conventional treatment (creatinine: 28.8±14.5 vs 7.5±12.1micromol/L, p=0.003) (BUN: 3.08±2.1 vs 0.91±1.5mmol/L, p=0.017). In PD group, survivors (n=5) had higher mean arterial pressure in the 6 hours prior to PD that non-survivors (n=4) (55.3±9.6 vs 40.0±3.6 mmHg, p=0.019). Survivors had also higher pH 24 hours after PD (7.37±0.03 vs 7.31±0.02, p=0.014), better creatinine variation (-3.6±5.8 vs 29.0±13.0micromol/L, p=0.02), and better diuresis improvement (4.4±3.2 vs 0.23±1.1ml/kg/h, p=0.039). There was no mortality difference between early and late PD. There were no major complications with PD. Conclusion: PD is safe for AKI after heart surgery. It has better outcome on BUN and creatinine levels. PD mortality is higher with low cardiac output, persistence of acidosis and absence of creatinine or diuresis improvement.","PeriodicalId":388959,"journal":{"name":"Journal of Pediatrics & Neonatal Care","volume":"59 1","pages":"0"},"PeriodicalIF":0.0000,"publicationDate":"2019-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Peritoneal dialysis after pediatric cardiac surgery: benefits and risks\",\"authors\":\"S. Saadé, N. Hanna, C. Mourani\",\"doi\":\"10.15406/jpnc.2019.09.00396\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Introduction: Neonates and infants having surgical repair for congenital heart disease are at risk of developing acute kidney injury (AKI). Our objectives were to determine surgeries most associated with AKI, to compare effect of peritoneal dialysis (PD) and conventional treatment, and to study the risk factors associated with PD mortality. Materials and methods: Records of Children who underwent cardiac surgery from November 2016 until December 2017 were reviewed. Clinical and biological effects of PD and conventional treatment were compared. In PD group, subgroups of survivors and non-survivors were compared to study risk factors for mortality associated with PD. We compared mortality between early and late PD (more than 24 hours after surgery). Results: 134 children were operated during the study period. 27 (20%) developed AKI and 9 of those (33%) received PD. Arterial switch was most associated with AKI (71.4%). PD had better effect in decreasing creatinine and blood urea nitrogen (BUN) levels after 48 hours treatment than conventional treatment (creatinine: 28.8±14.5 vs 7.5±12.1micromol/L, p=0.003) (BUN: 3.08±2.1 vs 0.91±1.5mmol/L, p=0.017). In PD group, survivors (n=5) had higher mean arterial pressure in the 6 hours prior to PD that non-survivors (n=4) (55.3±9.6 vs 40.0±3.6 mmHg, p=0.019). Survivors had also higher pH 24 hours after PD (7.37±0.03 vs 7.31±0.02, p=0.014), better creatinine variation (-3.6±5.8 vs 29.0±13.0micromol/L, p=0.02), and better diuresis improvement (4.4±3.2 vs 0.23±1.1ml/kg/h, p=0.039). There was no mortality difference between early and late PD. There were no major complications with PD. Conclusion: PD is safe for AKI after heart surgery. It has better outcome on BUN and creatinine levels. PD mortality is higher with low cardiac output, persistence of acidosis and absence of creatinine or diuresis improvement.\",\"PeriodicalId\":388959,\"journal\":{\"name\":\"Journal of Pediatrics & Neonatal Care\",\"volume\":\"59 1\",\"pages\":\"0\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2019-10-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Pediatrics & Neonatal Care\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.15406/jpnc.2019.09.00396\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Pediatrics & Neonatal Care","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.15406/jpnc.2019.09.00396","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

摘要

新生儿和接受先天性心脏病手术修复的婴儿有发生急性肾损伤(AKI)的风险。我们的目的是确定与AKI最相关的手术,比较腹膜透析(PD)和常规治疗的效果,并研究与PD死亡率相关的危险因素。材料和方法:回顾2016年11月至2017年12月接受心脏手术的儿童的记录。比较PD治疗与常规治疗的临床及生物学效果。在PD组中,将幸存者和非幸存者亚组进行比较,研究PD相关死亡率的危险因素。我们比较了早期和晚期PD(术后24小时以上)的死亡率。结果:研究期间共手术134例。27例(20%)发生AKI,其中9例(33%)接受PD治疗。动脉切换与AKI的相关性最高(71.4%)。PD治疗48h后肌酐和尿素氮(BUN)水平较常规治疗有较好的降低效果(肌酐:28.8±14.5 vs 7.5±12.1 μ mol/L, p=0.003) (BUN: 3.08±2.1 vs 0.91±1.5mmol/L, p=0.017)。PD组幸存者(n=5)在PD前6小时的平均动脉压高于非幸存者(n=4)(55.3±9.6 vs 40.0±3.6 mmHg, p=0.019)。幸存者PD后24小时pH值也较高(7.37±0.03 vs 7.31±0.02,p=0.014),肌酐变化较好(-3.6±5.8 vs 29.0±13.0微mol/L, p=0.02),利尿改善较好(4.4±3.2 vs 0.23±1.1ml/kg/h, p=0.039)。早期和晚期PD患者的死亡率没有差异。PD无重大并发症。结论:PD治疗心脏手术后AKI是安全的。对BUN和肌酐水平有较好的疗效。低心排血量、持续酸中毒和没有肌酐或利尿改善的PD死亡率较高。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
Peritoneal dialysis after pediatric cardiac surgery: benefits and risks
Introduction: Neonates and infants having surgical repair for congenital heart disease are at risk of developing acute kidney injury (AKI). Our objectives were to determine surgeries most associated with AKI, to compare effect of peritoneal dialysis (PD) and conventional treatment, and to study the risk factors associated with PD mortality. Materials and methods: Records of Children who underwent cardiac surgery from November 2016 until December 2017 were reviewed. Clinical and biological effects of PD and conventional treatment were compared. In PD group, subgroups of survivors and non-survivors were compared to study risk factors for mortality associated with PD. We compared mortality between early and late PD (more than 24 hours after surgery). Results: 134 children were operated during the study period. 27 (20%) developed AKI and 9 of those (33%) received PD. Arterial switch was most associated with AKI (71.4%). PD had better effect in decreasing creatinine and blood urea nitrogen (BUN) levels after 48 hours treatment than conventional treatment (creatinine: 28.8±14.5 vs 7.5±12.1micromol/L, p=0.003) (BUN: 3.08±2.1 vs 0.91±1.5mmol/L, p=0.017). In PD group, survivors (n=5) had higher mean arterial pressure in the 6 hours prior to PD that non-survivors (n=4) (55.3±9.6 vs 40.0±3.6 mmHg, p=0.019). Survivors had also higher pH 24 hours after PD (7.37±0.03 vs 7.31±0.02, p=0.014), better creatinine variation (-3.6±5.8 vs 29.0±13.0micromol/L, p=0.02), and better diuresis improvement (4.4±3.2 vs 0.23±1.1ml/kg/h, p=0.039). There was no mortality difference between early and late PD. There were no major complications with PD. Conclusion: PD is safe for AKI after heart surgery. It has better outcome on BUN and creatinine levels. PD mortality is higher with low cardiac output, persistence of acidosis and absence of creatinine or diuresis improvement.
求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
自引率
0.00%
发文量
0
期刊最新文献
The primary nutritional approach in pediatric celiac disease: a mini-review Prevalence and associated factor of neonatal mortality among neonates admitted to Asella referral and teaching hospital, Asella, Ethiopia, 2024 Efficacy and safety of Pranabb® syrup to reduce cough and improve sleep quality in children compared to usual recommended hydration measures Neonatal acidity and pyloric stenosis of infancy (PS) - the beginning and the end two stories PATAU SYNDROME- An Unusual Case of Congenital Abnormality
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1