Peritoneal Dialysis In Children With Acute Renal Insufficiency After Radical Correction Of Tetralogy Of Fallot

Objective: The incidence rate of acute renal insufficiency (ARI) on children who under went cardiac anomaly corrections of tetralogy of Fallot with hypothermic cardiopulmonary bypass is high. The causes are complex. Once ARI happens after operation, it can cause water retention, metabolic products'accumulation, hyperkalemia, acidosis and tissue edema, which can cause and aggravate pulmonary edema and low cardiac output. The prognosis is poor by simple drug treatment. Peritoneal dialysis has been used in large children cardiac center, as an important alternative method of the treatment of acute renal inadequacy. This report is to explore the treatment effect of peritoneal dialysis in children with acute renal insufficiency after radical correction of tetralogy of Fallot.Methods: To retrospective analysis 12 clinical cases, who had the application of Cardiac Surgery in Second Hospital of Hebei Medical University and peritoneal dialysis was as a treatment of acute renal insufficiency after radical operation on them from September 2009 to February 2011.They aged from 7 months to 2.5 years; weightd 7 ~ 11.5 kg. 12 patients were children with tetralogy of Fallot. Acute renal inadequacy occurred after radical correction of tetralogy of Fallot with hypothermic cardiopulmonary bypass. Given the children sedative analgesics, disinfected, local anesthesiaed with 1% lidocaine, made a surgical incision in the medioventral line 2 ~ 3cm below the umbilicus for placeing a straight tube which was used by children in peritoneal dialysis. Children needed peritoneal dialysate for 10 ~ 15 ml / kg each time. The period for the liquid going into the abdominal cavity was 30 mins, lasted for 20 ~ 40 mins, going away from the abdominal cavity was 30 ~ 40 mins. It needed about 1 ~ 2 h each time, 4 to 6 times every day. The treatments related to cardiac surgery were going on during dialysis to ensure respiration and circulation stablely, The volume of intake and output were stricty, central venous pressure ,blood gas analysis , blood electrolytes, BUN, Cr, albumin were determinaed if necessary. The situation of blood biochemistry, urine output could adjust the amount of dialysis, the dialysate concentration and dialysis interval. If necessary, continuous ambulatory peritoneal dialysis was feasible. According to the urine of patients, blood sugar and serum potassium, the volume of dialysate, glucose concentration and dialysis period could be regulated. If necessary, sodium bicarbonate, calcium gluconate and insulin could be added into the dialysate. Kcl with 0.15 ~ 0.3 g / L could be added as appropriate if patient appeared hypopotassemia. Through this research we want to improve our recognition of the treatment effect of peritoneal dialysis in children with acute renal insufficiency after radical correction of tetralogy of Fallot.Results: Two patients died because of severe low cardiac output syndrome after radical correction of tetralogy of Fallot. Another ten patients receiving early and positive peritoneal dialysis treatment are alive. Urinary outputs of them returned to normal levels through 22 to 120 hours after peritoneal dialysis treatment. Average duration of peritoneal dialysis treatment was 4.1±1.3 days. Fluid volume removed by peritoneal dialysis was 40.9±10ml / ( kg·day). Acidosis, low cardiac output syndrome, hyperkaliemia, hypoxia and arrhythmia were improved. Creatinine (Cr) and blood urea nitrogen (BUN) levels returned to normal. A leak surrounding the dialysis tube occurred in one patient. No dialysis tube blockage,abdominal infections, intestinal perforation, prolapse,hypoproteinemia, hyperglycemia, low sodium and low chloride hyperlipidemia occurred. All the survivals had normal renal function during a follow up period of 2 months to 1 year.Conclusions:1 Peritoneal dialysis is an effective method of ARI after radical correction of tetralogy of Fallot .2 It doesn't require systemic heparinization. Its'equipment is not complicated. It is simple to practice, low cost, safety, suitable for children.3 Peritoneal dialysis should be used as soon as possible after radical correction of tetralogy of Fallot if the patient gets with acute renal insufficiency.