何林洪　　胡兰

[摘要] 急性肾损伤（acute kidney injury，AKI）是先天性心脏病术后常见且严重的并发癥，其增加患儿术后死亡率，延长患儿术后机械通气时间和住院时间，是先心术后患儿不良预后的独立危险因素。液体管理是先心术后并发急性肾损伤治疗的关键，一方面患儿术后需要大量液体输注保证心输出量、各重要脏器的灌注，另一方面输液过多会加重AKI的发展，且目前尚缺乏十分有效的指标来评价患儿容量。本文将对儿童先心术后并发急性肾损伤液体管理目前研究的进展进行综述。

[关键词] 儿童；先天性心脏病；急性肾损伤；液体管理

[中图分类号] R726.5 [文献标识码] A [文章编号] 1673-9701（2018）10-0164-05

Progress of study on fluid management in children with acute kidney injury after congenital heart disease surgery

HE Linhong HU Lan

Department of Pediatric Intensive Care Unit， Children's Hospital of Chongqing Medical University， Ministry of Education Key Laboratory of Child Development and Disorders， China International Science and Technology Cooperation Base of Child Development and Critical Disorders， Chongqing Key Laboratory of Pediatrics， Chongqing 400014， China

[Abstract] Acute kidney injury（AKI） is a common and serious complication after congenital heart disease surgery. It increases the postoperative mortality rate and prolongs the postoperative duration of mechanical ventilation and hospitalization of children. It is an independent risk factor of poor prognosis of postoperative children with congenital heart disease. Fluid management is the key to the treatment of AKI after congenital heart surgery. On the one hand， children need a large amount of liquid infusion to ensure the cardiac output and perfusion of important organs after operation. On the other hand， excessive infusion may aggravate the development of AKI. At present， there is still a lack of effective indicators to evaluate the capacity of children. This article reviews the progress of current research on fluid management of postoperative congenital heart disease complicated by AKI.

[Key words] Child； Congenital heart disease； Acute kidney injury； Fluid management

急性肾损伤（acute kidney injury，AKI）是一组临床综合征，不同病因导致的AKI预防和干预方式不同。AKI是儿童先天性心脏病术后一种常见且严重的并发症，发生率在30%～60%之间，并显著增加患儿死亡率和术后机械通气时间、总住院时间[1-3]。目前已经成为大家关注的儿童健康问题[4]。对于儿童先天性心脏并合并急性肾损伤（cardiac surgery associated with acute kidney injury，CSA-AKI）现仍未找到十分有效的干预措施，液体管理是其治疗的关键。补液对AKI的预防和治疗还存在很多不确定性，如果不加以判断地给予补液，就会因液体过多而导致AKI自身发展或进一步恶化，甚至会影响肾脏功能的恢复[5]。液体类型的选择、患儿容量状态的评估和液体清除方法的选择对CSA-AKI液体管理十分重要。本文将对CSA-AKI中液体管理中液体类型的选择、对患儿容量状态的评估和液体清除方法进行简要综述。……