The Application Of Peritoneal Dialysis Treatment In Postoperative Infants With Congenital Heart Diseases

Objective The congenital heart disease is one of the most common cardiovascular malformations in infants and young children. In the perioperative stage, there is a high incidence of acute renal insufficiency or even acute renal failure in infants and young children after open-heart surgery, due to various factors. Once acute renal insufficiency happens after surgery, it can cause many complications such as water sodium retention, metabolite accumulation, electrolyte acid-base balance disorder, which can cause children to stay in the intensive care unit for a longer time and increased mortality. Internal medicine conservative treatment effect is bad, peritoneal dialysis treatment for postoperative acute renal insufficiency has good curative effect and it has been widely used in clinical practice.This paper mainly discusses the curative effect of peritoneal dialysis treatment in infants with acute renal insufficiency after open-heart surgery and summarizes the clinical experience.Methods The clinical data of 18 cases of infants and young children, including 13 cases of male, female in 5 cases; aged 21 days ~ 29 months, an averaged(5.58± 7.65) months;weighted 3 ~ 10 Kg, average(5.19±1.98) Kg; who had undergone the peritoneal dialysis therapy in our department during January 2014- December 2015 were retrospectively analyzed. Children with the whole group were acute renal insufficiency after open cardiac operation and received the peritoneal dialysis treatment. Given the infants sedation, regular disinfection shop towels, local infiltration anesthesia with 1% lidocaine, made a surgical incision in the left(or right) Mc Burney's point for imbeding a domestic Tenckhoff tube which was used by young children in peritoneal dialysis(the tube located in the rectal bladder fossa of male children, or in the womb rectum nest of female). Heated the 4.25% peritoneal dialysis solution to 37?or so, according to 10 ~ 30 ml/Kg into the abdominal cavity, kept 30 min ~ 3 h, opened 10 min ~ 7.5 h, it needed 1~8h each time and 3 ~ 24 times every day. At the same time during the dialysis treatment, continued to cardiac surgery routine therapy, which included respiration and circulation function support, strengthened nutrition support, actively prevented and controlled infection, avoided the use of renal toxicity, attached great importance to the internal environment stable maintenance, corrected of electrolyte acid-base balance disorders. Strictly monitored of liver and kidney function every day, every 4 ~ 8 h monitored blood gas analysis, recorded the urine output and the peritoneal dialysate intake and output per hour, calculated the ultrafiltration volume of peritoneal dialysis, according to the amount of peritoneal dialysis ultrafiltration, urine output, hemodynamic state, and the biochemical index to adjust the number and the cycle time of dialysis.Results Of the 18 children, 10 patients died, with the case fatality rate of 55.56%.The causes of death included respectively multiple organ failure 5 cases(50%), low cardiac output syndrome 3 cases(30%), arrhythmia and cardiac arrest 2 cases(20%). Complications happened to 2 patients during peritoneal dialysis(11.11%), 1 case was the peritoneal dialysis tube jam, to replace peritoneal dialysis tube; another 1 case was the abdominal cavity infection, it was cured after peritoneal lavage and antimicrobial therapy. The 8 cases of survival when they left the hospital, had completely normal urine volume, serum potassium, serum creatinine and blood urea nitrogen, etc.Conclusion Peritoneal dialysis for the equipment and the operation is simple, no systemic anticoagulation, little influence on hemodynamics, low cost, easy to care, especially for children, etc, has become a important renal replacement therapy of children with acute renal insufficiency. And it is an effective treatment method of infants and young children with acute renal insufficiency after open-heart surgery. The important risk factors for prognosis in infants and children after open heart surgery are complex heart malformations, multiple organ failure, low cardiac output syndrome and cardiac arrest.