目的 探讨连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)在新生儿急性肾损伤(acute kidney injury, AKI)中应用的有效性和安全性。 方法 回顾分析2015年1月～2021年10月上海市儿童医院新生儿科CRRT治疗的AKI患儿的临床资料。比较治疗前、治疗12～24h和治疗结束时尿素氮、肌酐、尿量和血管活性药使用情况，观察并发症和临床预后。 结果 共纳入12例患儿，男性9例，女性3例，胎龄(36.6±3.0)周，出生体质量(2765.4±697.6)g。原发病包括出生窒息7例，肺炎、先天性脐膨出、先天性空肠闭锁、败血症及胎粪吸入综合征(meconium aspiration syndrome,MAS)各1例。治疗日龄3(1.0,4.8)天，持续运转时间(73.5±59.5)h。其中4例治愈出院，1例放弃治疗出院，7例死亡，治愈出院与放弃或死亡患儿的治疗日龄无显著性差异(Z=-0.352，P=0.725)。出现并发症电解质紊乱8例，血小板减少5例，导管堵塞3例。与治疗前相比，治疗12～24h尿素氮显著下降 (Z =-2.118，P=0.034)，治疗结束尿素氮下降，但差异无统计学意义(Z=-1.257，P=0.232)。与治疗前相比，治疗12～24h、治疗结束时肌酐水平均显著下降(t=4.528，P=0.001；t=3.372，P=0.006)，尿量均显著升高(Z =-2.670，P =0.008；Z =-2.937，P =0.003)。治疗前使用血管活性药的患儿共11例，治疗12～24h 1例停用血管活性药，6例药物较前减量；治疗结束5例停用血管活性药，3例药物较前减量。 结论 CRRT治疗新生儿AKI是有效的、安全的，且并发症是可控的。
Objective To investigate the efficacy and safety of continuous renal replacement therapy(CRRT) in neonates with acute kidney injury(AKI). Method The AKI neonates treated with CRRT and admitted to our department from January 2015 to October 2021 were enrolled. Serum creatinine(Scr), blood urea nitrogen(BUN), urine output and the use of vasoactive drugs were analyzed at the three time points (before treatment, after 12-24 hours and at the end of the treatment). The complications and prognosis were also observed. Result A total of 12 neonates were involved, including 9 males and 3 females with gestational age of (36.6±3.0) weeks and birth weight of (2765.4±697.6)g. The primary diseases included birth asphyxia (7 cases), pneumonia (one case), congenital omphalocele (one case), congenital jejunal atresia (one case), neonatal septicemia (one case) and meconium aspiration syndrome (one case). Their median age was 3 (1, 4.8) days, and the operation time was (73.5±59.5) h. Finally, 4 patients survived, one patient was given up, and 7 patients died. There was no significant difference in age between cured neonates and those who died or were given up (Z=-0.352, P=0.725). The complications included electrolyte imbalance (8 cases), thrombocytopenia (5 cases) and tube blockage (3 cases). Compared with those before CRRT, BUN was significantly decreased 12～24h after CRRT (Z=-2.118, P=0.034), BUN showed a downward trend at the end of treatment, but the difference was not statistically significant (Z=-1.257, P=0.232); Scr levels were significantly decreased (t=4.528, P=0.001; t=3.372, P=0.006) and the urine output was significantly increased (Z=-2.670, P=0.008; Z=-2.937, P=0.003) after 12～24 hours of CRRT and at the end of CRRT. Eleven neonates were treated with vasoactive drugs before CRRT; after 12～24 hours of CRRT, one patient stopped using vasoactive drugs and 6 patients reduced the dosage; at the end of CRRT, 5 patients stopped using vasoactive drugs, and 3 patients reduced the dosage. Conclusion The application of CRRT in neonates with AKI is effective and safe, and the complications was controllable.
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