对儿童在家中行夜间血液透析

作     者：Geary D.F. Piva E. Tyrrell J. 虎小毅 

作者机构：Division of Nephrology Hospital for Sick Children 555 University Ave Toronto Ont. M5G 1X8 Canada 

出 版 物：《世界核心医学期刊文摘（儿科学分册）》 (Dkgest of the World Latest Medical Information)

年 卷 期：2006年第2卷第2期

页      面：29-30页

学科分类：0831[工学-生物医学工程（可授工学、理学、医学学位）] 1011[医学-护理学（可授医学、理学学位）] 08[工学] 10[医学] 

主　　题：血液透析 儿童 夜间 透析液流量 中心静脉导管 自由饮食 思想负担 学习注意力 NHD 磷酸盐 

摘      要：Objective: To describe the effect of home nocturnal hemodialysis (NHD) in North American children. Study design: Four teenagers underwent NHD for 8 hours, 6 to 7 nights/week, using either central venous lines or fistulae for periods of 6 to 12 months. Blood flow approximated 200 mL/min, and dialysate flow was 300 mL/min; the dialysate contained potassium and phosphate. The procedure was remotely monitored. Results: The children had unrestricted diets and fluid allowance and did not require phosphate binders. Persistent relative hypotension developed in 2 of 4 children. Weekly Kt/V urea values were consistently 10; other biochemical measures varied. Quality of life and school attendance improved in 3 of 4 children. The workload and reported emotional burden of NHD was substantial. No significant complications occurred. Dialysate losses of calcium, phosphate and carnitine required supplementation. The annual cost per patient was ＄ 64,000 Canadian, which represented a 27% savings compared with thrice weekly in-center hemodialysis. Conclusions: NHD is feasible in selected children, allows free dietary and fluid intake, and improves patient wellbeing. The burden on the family is substantial, and NHD requires support of a dedicated multidisciplinary team.