不同超滤功能的持续不卧床腹膜透析患者腹膜液体转运功能评估  

Ultrafiltration capacity and peritoneal fluid kinetics in continuous ambulatory peritoneal dialysis patients

作　　者：者星炜[1] 罗洁[1] 刘振华[1] 白云凯[1] 熊丽炎[1] 单亦升[2] 程磊[2] 田信奎[2] 汪涛[2] 

机构地区：[1]昆明医学院第一附属医院肾内科,昆明650031 [2]北京大学第三医院肾内科,北京100191

出　　处：《中国血液净化》2012年第5期241-244,共4页Chinese Journal of Blood Purification

基　　金：教育部长江学者奖励计划;教育部教育振兴行动计划专项基金(985工程);北京大学国家211计划(38-18)的资助; 云南省科技厅社会发展计划面上项目(2008ZC127M);昆明市科技局科技计划项目重点项目(昆科计字08S090104);院内博士启动金(2007bs08)的资助

摘　　要：目的容量控制对于腹膜透析至关重要。腹膜平衡实验(peritoneal equilibration test,PET)可以评估腹膜小分子溶质转动功能,对优化腹膜透析存腹时间提供依据,但是不能预测腹膜液体转运功能。所以,本研究使用计算机拟合对不同超滤功能腹膜透析患者的腹膜液体转运功能进行评估。方法纳入研究患者包括每天使用3～4袋2.5%葡萄糖透析液者(为腹膜超滤功能差组)和使用3～4袋1.5%葡萄糖透析液者(为腹膜功能好组),两组患者在上述透析处方下都能达到足够的液体清除。所有入组的患者都要求详细记录自己每天的腹膜透析换液情况,以评估腹膜液体转运功能。结果本研究包括了17名持续不卧床腹膜透析患者(continuous ambulatory peritoneal dialysis,CAPD),其中9名为超滤功能差组,8名为超滤功能好组。与超滤功能好组相比,超滤功能差组的患者每天更多的处于高葡萄糖(P<0.01)环境中,透析液/血浆肌酐比值(D/Pcre)更高(P<0.05),有更高的腹膜液体吸收率(Ke)(P<0.01)。结论与超滤功能好的患者相比超滤功能差的患者的腹膜小分子溶质转运率更高,更为重要的是,超滤能力差的患者腹膜液体吸收率更高。Objective Volume control is critical for peritoneal dialysis. Although peritoneal equilibration test (PET) has been used to clarify the peritoneal membrane characteristics, it is unable to adequately predict peritoneal fluid removal and appropriately optimize the dwelling time. In the present study, we applied computer simulation and performed a more detailed evaluation of the fluid kinetics in patients with different ultrafiltration (UF) capacity. Methods Patients who used three to four exchanges of 2.5% glucose dialysate per day (poor UF capacity group) and patients who used three to four exchanges of 1.5% glucose dialysate per day (good UF capacity group) to achieve adequate amount of peritoneal fluid removal were included in the present analysis. All included patients were asked to record appropriately their dialysis exchanges for assessment of their peritoneal fluid transport characteristics. Results Seventeen continuous ambulatory peritoneal dialysis patients were selected in the present study, nine in poor UF capacity group and eight in good UF capacity group. Patients in poor UF capacity group had significantly higher daily glucose exposure (P<0.01), higher dialysate-to-plasma ratio of creatinine (D/P creatinine) (P<0.05) values, and higher peritoneal fluid absorption rate (Ke) (P<0.01), as compared to patients with good UF capacity. Conclusions Our results suggest that patients with poor UF capacity have significantly higher peritoneal small solute transport rate, and more importantly, higher peritoneal fluid absorption rate as compared to patients with good UF capacity.

关 键 词：腹膜透析 流体力学 超滤容积 

分 类 号：R459.5[医药卫生—治疗学]