慢性肾功能衰竭老年患者早期低剂量腹膜透析的临床评价  

Clinical evaluation of early low-dosage peritoneal dialysis in elder chronic renal failure patients

作　　者：张苗[1] 蒋春明[1] 孙琤[1] 孙娜[1] 

机构地区：[1]南京大学医学院附属鼓楼医院肾脏内科,江苏南京210008

出　　处：《医学研究生学报》2004年第12期1085-1087,共3页Journal of Medical Postgraduates

基　　金：江苏省社会科技发展基金资助项目 (批准号 :BS2 0 0 2 0 0 3 )

摘　　要：目的 :探讨老年慢性肾功能衰竭 (CRF)患者早期低剂量腹膜透析 (PD)的临床价值。　方法 :老年CRF患者16例 ,年龄 (6 7.4± 4 .5 )岁。采用尿素氮清除率和肌酐清除率两者的平均值作为肾小球滤过率 (GFR)的指标 ,GFR10 .7～ 11.7(平均 11.2± 1.8)ml/min ,以每周尿素清除指数 (Tkt/v) >2 .0、总肌酐清除率 (TCcr) >6 0L/周作为透析充分性 ,制定和调整每天透析液用量 ,选用 1.5 %PD液为主 ,根据液体平衡的需要 ,换用小部分 2 .5 %PD液。总结随访 1年的透析情况。　结果 :每天单位体表面积透析剂量 (PV/S)为 3.2 1～ 3.36L/m2 ,一年内残余肾功能无明显下降 (P >0 .0 5 )。大部分患者食欲增加 ,体力增强 ,血清清蛋白透析前为 (33.7± 5 .4 )g/L ,透析后为 (37.1± 4 .4 )g/L ,差异具有显著性意义 (P <0 .0 5 )。主观综合性营养评估 (SGA)显示营养状况明显改善。血红蛋白明显提高 (P <0 .0 5 ) ,透析前为 (71.0± 6 .8)g/L ,透析 1年后为 (99.1± 7.9)g/L ,只有 5例患者应用促红细胞生成素。透析前 1年与透析后 1年的住院率分别为 11/ 16 (6 8 75 % )与 4 / 16 (2 5 0 % ) ,透析后明显降低 (P <0 .0 5 )。结论 :早期开始低剂量PD可改善老年CRF患者的营养和贫血状况 ,提高生活质量 ;并且保护机体各器官 。Objective: To investigate the clinical value of early low-dosage peritoneal dialysis in elder chronic renal failure patients. Methods:16 elder patients aged from 64 to 74 with chronic renal failure were included in this study.Glomerular filtration rate(GFR),expressed by the average of urea and creatinine clearence rates,of all the patients changed from 10.7 to 11.7 ml/min.The dialysis dose was adjusted according to the guide-line of peritoneal dialysis adequacy demanding Tkt/v>2.0,TCcr> 60 L/W. Most of the patients accepted the peritoneal dialysate containing 1.5% glucose,while some patients accepted the peritoneal dialysate containing 2.5% glucose interruptedly to get more fluid removal. The clinical data of the 16 cases were collected before the renal replacement treatment and 6,12 months after the treatment. Results: The dialysis dose(PV/S) of all the patitents was 3.21～3.36 L/m 2.There was no significant difference in residual renal function during the one-year period of treatment, P>0.05.Food appetite and physical status were improved in most of the patients after the treatment of peritoneal dialysis. The serum albumin level after peritoneal dialysis was significant higher as compared with the pre-dialysis state,(37.1±4.4)g/L vs (33.7±5.4) g/L,P<0.05. Subjective global assessment was also improved significantly, P<0.05. Although only five patients received recombinant human erythropoietin treatment,the hemoglobin levels one year after the dialysis were significant higher than those before the dialysis, (99.1±7.9)g/L vs (71.0±6.8)g/L, P<0.05. And after the dialysis,the rates of hospitalization were significantly reduced,P<0.05. Conclusion: Early low-dosage peritoneal dialysis can improve the nutritional status,hemoglobin and quality of life in elder chronic renal failure patients and reduce the hospitalization rates.

关 键 词：腹膜透析 老年 慢性肾功能衰竭 早期 

分 类 号：R692.5[医药卫生—泌尿科学]