持续性非卧床腹膜透析患者如何合理选择透析剂量  

How much peritoneal dialysis is required for Chinese people to maintain dialysis adequacy?

作　　者：俞雨生[1,2] 沈克勤[1,2] 樊荣[1,2] 胡伟新 姚小丹[1,2] 唐政 季大玺[1,2] 黎磊石 

机构地区：[1]南京军区南京总医院 [2]解放军肾脏病研究所

出　　处：《中华内科杂志》1998年第3期154-157,共4页Chinese Journal of Internal Medicine

摘　　要：目的前瞻性观察了不同透析效能与透析剂量的关系，从而寻找出适合国人特点的透析剂量。方法对４４例病人共１３４例次测定按ＮＣＤＳ标准分为充分（４４．０％）、临界（２３．１％）及不充分（３２．８％）三组，观察各组病人之间尿素ＫＴ／Ｖ、肌酐清除率、蛋白质表现率和血浆白蛋白、残余肾功能（ＲＲＦ）、透析总量（ＰＶ）及单位体表面积透析剂量（ＰＶ／ＢＳＡ）改变及相互关系。结果三组病人在上述指标上有明显的差异（Ｐ＜０．００１）。分析ＰＶ与ＰＶ／ＢＳＡ反映透析效能诸因素之间的相关性显示，后者较前者更为显著（Ｐ＜０．０１）。分析透析充分组病人ＰＶ／ＢＳＡ与ＲＲＦ之间的Ｐｅａｒｓｏｎ相关系数发现，合理的透析剂量应为：ＰＶ（Ｌ／ｄ）＝（５．６－０．２４×ＲＲＦ）×ＢＳＡ。结论所有腹透病人应采取个体化的透析剂量，以上述公式计算透析剂量。Objective To evalute the relationship between the dialysis adequacy and dialysis dosage and aid to prescribe or monitor dialysis dose. Methods A prospective study with 134 times of observation was carried out in 46 stable peritoneal dialysis patients. All patients were divided into adequacy in between and inadequacy groups based on the criteria used by the National Cooperation Dialysis Study in USA. Multiple univariate ANOVA and Pearson R coefficients were performed according to the standard procedures on dialysate volume and adequacy data. Results There was a marked difference in peritoneal dialysate volume (PV) as compared with peritoneal dialysate volume/body surfase area (PV/BSA) for the three groups ( P <0.05 vs P <0.0001). Univariate analysis of the relationship between the dialysis dosage and urea KT/V, Alb and nPNA showed that PV/BSA correlated positively with urea KT/V, Alb and nPNA ( r =0.53-0.83, P <0.05～0.01), while PV correlated positively only with urea KT/V ( r =0.48, P <0.05). PV/BSA coorelated more significantly with urea KT/V than PV, so it was more influencing on the dialysis adequacy. The relationship between PV/BSA and RRF was performed in adequacy group patients with univariate analysis, the Pearson R coefficient was PV/BSA(L)=5.6-0.24×RRF ( r =-0.6252, P <0.01). Conclusion In order to keep adequacy in dialysis, the prescription of dialysis must be individualized and the dosage of PD depends on the patient′s BSA, RRF and so on.

关 键 词：腹膜透析 肾功能衰竭 慢性 透析剂量 

分 类 号：R692.505[医药卫生—泌尿科学] R459.5[医药卫生—外科学]