日间不卧床腹膜透析与持续不卧床腹膜透析对心血管并发症的影响  

Affects of daytime and continuous ambulatory peritoneal dialysis on cardiovascular complications in patients with ESRD

作　　者：王涵[1] 周岩[2] 李韬彧[2] 周婷婷[2] 李晴[2] 刘志红[2] 俞雨生[2] 

机构地区：[1]南京大学医学院 [2]南京军区南京总医院 全军肾脏病研究,南京210016

出　　处：《肾脏病与透析肾移植杂志》2013年第5期427-433,共7页Chinese Journal of Nephrology,Dialysis & Transplantation

摘　　要：目的:比较日间不卧床腹膜透析(DAPD)与持续不卧床腹膜透析(CAPD)对心血管并发症的影响。方法:将2010年6月至12月行PD置管术的64例患者,随机分成CAPD组和DAPD组,每组32例。观察两组患者充血性心力衰竭、恶性高血压等心血管并发症的发生率、发生时间及转归,每半年进行一次容量及心功能的评估,行心脏超声和胸部平片检查,动态观察透析前、透析12月和24月患者心胸比例,左心室内径、左心房内径、左心室壁厚度、右心室内径、室间隔厚度等心血管系统相关指标及血压、透析效能、残余肾肾小球滤过率的变化情况。结果:(1)CAPD组患者1、2年心血管事件发生率为16%、28%,而DAPD组分别为6%和13%(P<0.05),随着透析时间延长,其发生率增加。(2)CAPD与DAPD患者入组时心胸比例无统计学差异,随访至24月CAPD组患者心胸比例明显大于DAPD组(0.51±0.04 vs 0.48±0.05,P<0.05),同时两组左心室内径分别为52.66±6.49 mm,48.69±4.70 mm(P<0.05)。(3)在末次随访中,以血压<140/90 mmHg为标准,CAPD组患者的血压达标率明显低于DAPD组患者(54.2%vs 84.8%,P<0.05)。(4)在透析效能方面,两组溶质清除均充分,且无明显差异。结论:采用DAPD模式的患者较CAPD患者心功能不全发生率低,心胸比例变化小,对心血管系统影响小,可能与容量负荷、残余肾功能状态有关。Objective： To investigate the cardiovascular complications in daytime ambulatory peritoneal dialysis （DAPD） and continuous ambulatory peritoneal dialysis （CAPD）. Methodology：In this prospective study, sixty four patients which received peritoneal dialysis （PD） from June 2010 to December 2010 were enrolled and randomized into group CAPD and group DAPD. The patients with CAPD were treated by using the dialysate 6 ～ 8 L/day, and peritoneal dialysate left in abdomen cavity at night and the patients with DAPD were treated by using the dialysate 6～8L at daytime, and evacuated of dialysate from abdomen at night. The parameters of incidence rate, time and prognosis of congestive heart failure, malignant hypertension and some other cardiovascular complication were observed between two groups. The cardiac function and construct including the dynamic changes of cardiothoracic ratio, left ventricular internal diameter, left atrial diameter,left ventrieular wall thickness, right ventricular diameter, and interventricular septal thickness, were detected by eehocardiography and chest radiograph every 6 month in all patients. Meanwhile, the blood pressure, dialysis adequacy and residual glomerular filtration rate were also investigated. Results： （ 1 ） 1,2-year of the chronic heart failure （CHF） incidence was 16% ,28% in group CAPD, and 6% , 13% in group DAPD respectively （P 〈 0. 05 ）. With the extending of time on PD treatment, the CHF incidence was gradually increasing. （2） The CTR had no difference between two groups at baseline,but at the end of follow-up the CTR of group CAPD and DAPD were 0.51±0.04, 0. 48±0.05 respectively （P 〈 0.05 ）. The left ventricular internal diameter of group CAPD and DAPD were 52. 66 ~ 6.49,48.69± 4.70 mm respectively,and there was a significant difference （ P 〈 0.05 ）. （ 3 ） At the end of follow-up, blood pressure 〈 140/90 mmHg as a standards,the compliance rate of BP was 54. 2% ,84. 8% in group CAPD and DAPD（P 〈0. 05） ,the rate of

关 键 词：腹膜透析 心血管 透析模式 

分 类 号：R459.5[医药卫生—治疗学]