Objective To summarize the experience of open heart operation on neonates with critical and complex congenital heart diseases and evaluate the methods of perioperative management. Methods From May 2001 to January 2003, 12 patients of neonates with congenital heart diseases underwent emergency operation. Their operating ages ranged from 6 to 30 days, the body weights were 2.8 to 4.5 kg. Their diagnoses included D-transposition of the great arteries in 4 cases, ventricular septal defect with atrial septal defect in 5 cases, complete atrioventricular septal defect, obstructed supracardiac total anomalous pulmonary venous drainage and cardiac rhabdomyomas in 1 case respectively. 12 cases were operated under moderate or deep hypothermic cardiopulmonary bypass. Results All cases were observed in ICU for 2-11 days and discharged 7-19 days after operation. The postoperative complications included low cardiac output, mediastinal infection, respiratory distress syndrome, systemic capillary leak syndrome and acute renal failure. All cases were cured and the follow-up (from 6 months to 2 years) showed satisfactory outcome. Conclusion A particular cardiopulmonary bypass and proper perioperative management is very important to ensure the successful outcome. Peritoneal dialysis is an effective and safe method for treating acute renal failure after cardiac operation in neonates.
Objective To assess the possible causes of acute pancreatitis (AP) in long term peritoneal dialysis (PD) and hemodialysis (HD) patients, and to discuss the diagnosis and treatment of AP in this kind of patients. Methods The clinical data of 9 cases of AP in PD and HD patients who were admitted in the hospital during January 1993 and January 2000 were analysed retrospectively. Results The serum levels of amylase of all the 9 cases were over three and a half times of upper limit value of healthy subjects. B mode ultrasound and CT scan examinations were useful for diagnosis of AP. Eight patients recovered very well with conservative treatment, while one patient who was diagnosed as acute severe pancreatitis and complicated with shock died. Conclusion Long term PD and HD patients are predisposing to develop AP. Diagnosis of AP in these patients primarily depends on the detection of serum amylase. Dialysis treatment is indispensable for cure of AP.
Objective To assess the cost-utility study of renal transplantation compared with nemodialysis (HD) and peritoneal dialysis (PD). Methods A prospective study of end-stage renal disease patients was followed up for 3 months after renal replacement therapy. The study population included 196 patients (renal transplant [RT] n=63, hemodialysis [HD] n=82 and continious ambulatory peritoneal dialysis [CAPD] n=51) from 6 hospitals of Sichuan province. Health-related quality of life was assessed by using the WHOQOL-BRIEF questionnaire. Utility scores were obtained so as to conduct CUA (cost-utility analysis). Costs were collected from financial department and by patient interview. Results The utility values were 0.539 9± 0.013 for RT, 0.450 8± 0.014 for HD, 0.512 2±0.099 for CAPD, respectively. The mean direct cost of the first three months of renal transplant was significantly higher than dialysis (RT and CAPD). Over 3 months, the average cost per quality-adjusted life year (QALY) for patients after CAPD was lower than HD and RT. Compared to HD, incremental cost analysis showed that CAPD was more ecnomical than RT. Sensitive analysis showed that CAPD was more effective than RT when ΔQALY varied in the limit of 95% confidence interval. However, the cost-utility of RT vs HD and CAPD vs HD was varied with ΔQALY level. Conclusions Cost-utility analysis showed that CAPD was a more favorable cost-utility ratio when compared to RT at early stage RT vs HD and CAPD vs HD, but which cost-utility ratio is better, we can not draw a certain conclusion.
Peritoneal dialysis (PD) represents an essential renal replacement therapy for end-stage renal disease patients. However, conventional glucose-based dialysis solutions limit the clinical adoption of PD due to complications including peritoneal fibrosis and metabolic disturbances. This review systematically elaborates on advances in novel biocompatible osmotic agents: L-carnitine improves peritoneal metabolic homeostasis, while hyperbranched polyglycerol enables sustained ultrafiltration with dual peritoneal/renal protection. These innovations delineate the future direction for osmotic agent development: integrating multifunctional properties (anti-fibrotic, pro-repair, and metabolic regulation) beyond foundational osmotic efficacy.
Objective
To investigate the efficacy and safety of ultrasound-guided TAP block for the anesthesia in peritoneal dialysis (PD) catheter implantation.
Methods
Patients with end-stage renal disease who intended to receive PD catheter implantation in the West China Hospital of Sichuan University were enrolled from April 2015 to February 2016. Those who met the inclusion criteria were randomly divided into two groups: the local filtration anesthesia (LF) group and the TAP group. The two groups got the ultrasound guided TAP block (The LF group got a shame TAP block by making the skin wheal and just inserting the needle into the TAP with the guidance of ultrasound), then the LF group received local filtration anesthesia twenty minutes later, with the TAP group had sham LF anesthesia by injection of saline at the incision subcutaneously. The anesthetist generated the random allocation sequence and performed all TAP/sham blocks according to the allocation of each patient. The patients, investigators were all blind to the allocation. The follow-up time was 3 months. The primary outcomes were the rate of alteration to general anesthesia and the VAS score during and after the surgery. The dosages of sufentanil for analgesia during and after were recorded. The satisfaction to the effect anesthesia by the operation doctors, PD catheter related complications and adverse events related to TAP block or anesthetic agent were also recorded. Statistic analysis was conducted using SPSS 19.0 software.
Results
A total of 36 patients were included, 12 cases in the LF group and 24 cases in the TAP group. The rate of alteration to general anesthesia in the TAP group was 4.12% and was significantly lower than that in the LF group (33.3%) (P=0.034). The VAS scores at the time points of incision of skin, division of subcutaneous tissue and anterior rectus sheath, opening the peritoneum, insertion of PDC, suture of skin, 2 hours and 24 hours after operation were significantly lower in the TAP group compared to the LF group (P values=0.001, 0.037, 0.000, 0.001, 0.029, 0.035, and 0.000, respectively). The TAP group consumed less sufentanil during the operation and showed a higher satisfaction of the operation doctors. There were no significant differences in the PD catheter related complications and adverse events between the two groups.
Conclusion
The ultrasound-guided TAP block can be an effective and safe anesthesia method for PD catheter implantation. Because of the limitation of small sample size of this study, a multiple center study with larger sample size is suggested.
ObjectiveTo explore and discuss the effects of lanthanum carbonate on serum calcium and phosphorus of continuous ambulatory peritoneal dialysis (CAPD) patients with chronic renal failure receiving calcitriol pulse therapy due to secondary hyperparathyroidism (SHPT).
MethodsCAPD patients caused by SHPT in peritoneal dialysis centre of the Qingdao Municipal Hospital of Eastern Hospital from March to June, 2013 were selected and randomly divided into two groups (lanthanum carbonate group and calcium carbonate group). The lanthanum carbonate group were treated with oral lanthanum carbonate and calcitriol pulse therapy, while the calcium carbonate group were treated with calcium carbonate and calcitriol. Change of levels of serum calcium, phosphorus and iPTH were observed and statistic analysis was conducted using SPSS 17.0.
ResultsA total of 40 CAPD patients were included, 20 cases in each group. After 12-week treatment, levels of serium phosphate (t=5.095, P=0.000) and iPTH (t=1.225, P=0.000) in the lanthanum carbonate group were significantly lower than those before treatment. The levels of serum calcium (t=1.127, P=0.001) and phosphate (t=2.035, P=0.000) in the lanthanum carbonate group were significantly lower than those in the calcium carbonate group (P < 0.05).
ConclusionLanthanum carbonate serves as a useful approach to improve hypercalcemia and the hyperphosphatemia in CAPD patients receiving calcitriol pulse therapy due to SHPT.
ObjectivesTo systematically review the influence for catheter mechanical dysfunction of different peritoneal dialysis catheterization methods.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases were searched to collect randomized controlled trials (RCTs) and cohort studies on comparisons of different peritoneal dialysis catheterization from inception to March 31st, 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Network meta-analysis was then performed by using ADDIS 1.16.6 software.ResultsA total of 33 studies (9 RCTs and 24 cohort studies) involving 3 301 patients were included. Network meta-analysis showed that the incidence of catheter mechanical dysfunctionwas the least and had statistically significant difference compared with that in percutaneous catheterization (OR=3.60; 95%CI, 1.64 and 15.38) and open surgery catheterization (OR=5.86; 95%CI, 2.68 and 14.53). Percutaneous catheterization was superior to open surgery catheterization, but there was no significant difference.ConclusionsLaparoscopic catheterization may be the best technique for catheter insertion in peritoneal dialysis considering catheter dysfunction. Each technology has its own advantages. Choice of insertion method should be based on the characteristics of both the patient and the insertion techniques.
Objective To summarize our experience of cardiovascular surgery for patients dependent on dialysis, and evaluate its safety and efficacy.?Methods?Clinical data of 10 consecutive patients dependent on maintenance dialysis underwent cardiovascular operations between Dec. 2004 and April 2011 in Peking Union Medical College Hospital were analyzed retrospectively. There were 6 male and 4 female patients, aged between 23 to 71 （57.6±13.2） years. They were put on dialysis 3-98 （25.2±30.6） months prior to operation due to diabetic nephropathy in 6 patients, chronic glomerulitis in 3 patients and systemic lupus erythemus in 1 patient, and 8 were dependent on hemodialysis and 2 on peritoneal dialysis. Five patients underwent coronary artery bypass grafting, one underwent Bentall procedure，two underwent aortic valve replacement, one underwent mitral valve replacement, and one underwent superior vena cava thrombectomy and patch repair. Patients underwent dialysis on the day before elective operation, followed by continuous ultra-filtration during cardiopulmonary bypass, and then bedside heparin-free continuous veno-venous hyperfiltration-dialysis started 5-32 hours after the operation. Conventional peritoneal dialysis or hemodialysis was resumed 4-7 days after operation.?Results?All operations were successfully completed. Cardiopulmonary bypass time was （125.8±33.5）minutes, aortic clamp time was（77.2±25.5） minutes. One in-hospital death occurred due to septic shock after deep chest wound infection. One patient underwent re-exploration due to pericardial temponade to achieve hemostasis. Three patients experienced atrial fibrillation and were all converted to sinus rhythm by amiodarone. Nine patients recovered to discharge and were followed-up for 8-76 months. Two late deaths occurred due to intracranial hemorrhage and liver carcinoma respectively. Seven survived patients were all in New York Heart Association grade II functional class, and none of them experience major advertent cardiac events related to grafts or prosthetic valve. One patient switched to hemodialysis 14 months after discharge due to peritonitis.Conclusion?Cardiovascular surgery can be practiced in patients dependent on maintenance hemodialysis or peritoneal dialysis with appropriate peri-operative management, so that symptoms can be relieved and quality of life improved.
