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中国循证儿科杂志

中国循证儿科杂志 ›› 2018, Vol. 13 ›› Issue (5): 355-358.

• 论著 • 上一篇    下一篇

儿童终末期肾病全自动腹膜透析并发症与休整期相关性分析

周清1,王君俏2,李国民1,赵蕊1,翟亦辉1,沈茜1,徐虹1,龚一女1,沈霞1   

  1. 1 复旦大学附属儿科医院 上海，201102；2 复旦大学护理学院 上海，200032
  • 收稿日期:2018-04-23 修回日期:2018-10-25 出版日期:2018-10-25 发布日期:2018-10-25
  • 通讯作者: 王君俏

A correlational study between complications and break-in period among children with end-stage renal disease on automatic peritoneal dialysis

ZHOU Qing1, WANG Jun-qiao2, LI Guo-min1, ZHAO Rui1, ZHAI Yi-hui1, SHEN Qian1, XU Hong1, GONG Yi-nv1, SHEN Xia1   

  1. 1 Children's Hospital of Fudan University, Shanghai 201102, China; 2 School of Nursing, Fudan University, Shanghai 200032, China
  • Received:2018-04-23 Revised:2018-10-25 Online:2018-10-25 Published:2018-10-25
  • Contact: WANG Jun-qiao

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摘要： 目的：分析儿童终末期肾病腹腔镜及开放手术置管腹膜透析并发症的危险因素。方法：复旦大学附属儿科医院（我院）诊断为终末期肾病、符合慢性腹膜透析（CPD）的适应证、行腹膜透析置管术且术后接受休整期（置管术后至开始腹膜透析的间隔时间）观察并起始透析的患儿。根据腹膜透析后6个月内有无并发症（导管移位、堵塞、渗漏，疝，腹膜透析相关腹膜炎，出口感染，隧道感染等）分为2组，考察并发症与休整期和不同置管方式（腹腔镜和开放手术）相关性。结果：符合本文纳入标准的CPD患儿144例，男84例，平均年龄（8.8±3.8）岁，腹腔镜置管83例，开放手术置管61例，透析前白蛋白（35.8±7.8）g·L-1。有并发症组（n=54)和无并发症组（n=90)性别、年龄、BMI、休整期、原发病、透析前白蛋白、是否大网膜切除差异均无统计学意义,与腹腔镜和开放手术置管差异有统计学意义（30.1% vs 47.5%，P＝0.03）。腹腔镜较开放手术置管腹膜透析相关腹膜炎发生率低（6.0% vs 18.0%, P＝0.02），导管移位、堵塞、渗漏，疝，出口感染，隧道感染等发生率差异均无统计学意义。结论：腹腔镜与开放手术置管比较，腹膜透析相关并发症少，休整期不影响腹膜透析相关并发症。

Abstract: Objective:To investigate the influencing factors of the complications of automatic peritoneal dialysis after laparoscopic and open peritoneal dialysis catheter insertion among children with end-stage renal disease. Methods:Children diagnosed as an end-stage renal disease, placed with peritoneal dialysis catheter, and on peritoneal dialysis in our center were recruited and divided into two groups based on the presence of complications including migration, obstruction, leakage, hernia, peritoneal dialysis-related peritonitis(PD-related peritonitis), and exit site and tunnel infections. The relationships between complications within 6 months after insertion and break-in period and methods of the catheter insertion were analyzed. Results:Totally 144 children were included in our study, including 84 males. Mean age was 8.8 ± 3.8 years old. Mean serum albumin predialysis was 35.8±7.8 g·L-1. Laparoscopic catheter insertion was performed in 83 children while open catheter insertion in 61 children. Gender, age, BMI, break-in period, pre-dialysis serum albumin, whether with omentectomy didn't indicate the statistical significance between complications and non-complication groups. The incidences of overall complications and peritonitis(30.1% vs 47.5%, P＝0.03) during the 6 months after insertion in the laparoscopic group were lower than the open catheter insertion group. There was no significant difference in other complications. Conclusion:Compared with the open peritoneal dialysis catheter insertion, the laparoscopic method has fewer PD-related complications. Additionally, the break-in period didn't have an impact on the complications included.