中国实用儿科杂志

中国实用儿科杂志 ›› 2011, Vol. 26 ›› Issue (06): 429-.

• 论著 • 上一篇    下一篇

儿童维持性血液透析23例临床分析

  

  1. 首都医科大学附属北京儿童医院儿科学国家重点学科，北京　100045
  • 收稿日期:2011-04-15 修回日期:2011-05-10 出版日期:2011-06-05 发布日期:2011-07-05
  • 基金资助:

    首都医学发展科研基金（2007-2061）；北京市优秀人才培养（2009D003008000001）

Clinical analysis of maintenance hemodialysis in children.

  1. National Key Discipline of Pediatrics （Capital Medical University）， Ministry of Education， Beijing Children’s Hospital， Capital Medical University， Beijing， 100045，China
  • Received:2011-04-15 Revised:2011-05-10 Online:2011-06-05 Published:2011-07-05

摘要：

探讨应用维持性血液透析（maintenance hemodialysis，MHD）治疗的终末期肾病（end-stage renal disease，ESRD）患儿的临床特点，为今后儿童MHD的治疗提供参考。方法　首都医科大学附属北京儿童医院血液净化中心2000年1月至2011年3月因ESRD行MHD的患儿共23例，其中男12例，女11例；年龄2.5～15.6岁。对其原发病、退出原因、透析并发症及透析充分性等进行统计和回顾性分析。 结果　在MHD儿童中ESRD的原发病中慢性肾小球肾炎8例，居首位，占34.8%，原因不明者5例，占21.7%。HD开始时均以临时中心静脉双腔管为血管通路，87.0%成功建立动静脉内瘘。动静脉瘘组尿素清除指数（spKt/V）（1.52±0.39），尿素下降率为（70.70±10.52）%，明显优于临时静脉双腔管组的（1.08±0.50）和（56.44±17.33）%。透析并发症以高血压、低血压和透析失衡综合征为常见，高血压发生率达87.0%，而低血压和失衡综合征发生率仅为5.6%和4.7%。退出原因43.5%为回当地医院透析， 17.4%肾移植，死亡1例（4.3%），放弃治疗2例（8.7%）。结论　我国慢性肾脏病儿童的筛查和管理还很欠缺；ESRD儿童及时建立动静脉瘘以保证透析充分性。

关键词: 终末期肾病, 维持性血液透析, 儿童

Abstract:

To provide the reference of future treatment for end stage renal disease （ESRD） in children by analyzing the clinical characteristics of ESRD patients on maintenance hemodialysis （MHD）.  Methods　23 cases including 12 males and 11 females aged from 2.5 to 15.6 years on MHD were analyzed. The cause of ESRD and exiting MHD， complication of HD and dialysis adequacy were assessed. Results　The main cause of ESRD was chronic glomerulonephritis（87.0%）， whereas 21.7% patients of unknown reason. The vascular accesses of all patients were temporary dual-lumen catheters when initiating HD. About 87.0% established arterio-venous fistula successfully later. The mean spKt/V was （1.52±0.39） and URR was （70.70±10.52）% in patients with fistula， which was much higher than （1.08±0.50） and （56.44±17.33）% in patients of catheters respectively. The main complications were hypertension（87.0%），hypotension（5.6%）and dialysis disequilibrium syndrome （4.7%）. The reasons of exiting our treatment were going back to local hospital （43.5%）， renal transplantation （17.4%）， giving up treatment （8.7%） and death （4.3%）. Conclusion　There is lack of screening and systematic monitoring of ESRD children in our country. Our results indicate that ESRD children should establish arterio-venous fistula as soon as possible in order to achieve HD adequacy. The complication of hypertension should be paid more attention. HD and renal transplantation were main treatment of ESRD children older than school age.

Key words:  , end stage renal disease；maintenance hemodialysis；child