日间小剂量递增腹膜透析在终末期肾病患者的应用研究  

Observation and application of daytime small dose escalation peritoneal dialysis in patients with end-stage renal disease

作　　者：龚蓉[1,2] 皮婧静[1,2] 全大勇[1,2] 佘宁兰[1,2] 梁柱[1,2] 舒英[1,2] 李迎春[1,2] 

机构地区：[1]重庆医科大学附属成都第二临床学院 [2]成都市三人民医院肾脏科,610031

出　　处：《中华临床医师杂志（电子版）》2013年第24期72-75,共4页Chinese Journal of Clinicians(Electronic Edition)

基　　金：四川省卫生厅科研课题基金(120541)

摘　　要：目的：研究并探讨终末期肾病患者非卧床腹膜透析不同透析模式的临床疗效。方法通过对终末期肾病腹膜透析患者残肾功能较好的患者采取不同的透析模式，将患者随机分为两组：日间小剂量递增组（26例），透析液总量每日4.5～8 L，夜间不留腹；持续标准透析剂量组（24例），每日透析液量8 L，夜间留腹，比较两组研究开始与终点的营养指标、血生化指标、透析充分性、残肾功能、胱抑素 C。结果两组患者至观察终点血浆白蛋白、24 h尿量、残肾功能、胱抑素C比较差异有统计学意义（P＜0.05）。两组血K＋、血P3＋、二氧化碳结合力（CO2CP）、24 h超滤量、透析充分性指标每周总尿素氮清除率（Kt/V）、每周总肌苷清除率（Ccr），比较差异无统计学意义（P＞0.05），两组置管后1个月内导管堵管、渗漏发生率比较差异无统计学意义（P＞0.05）。两组的每日透析液总量和透析时间均有统计学差异（P＜0.05）。结论（1）残肾功能较好的终末期肾病患者，置管后早期采用日间小剂量递增式腹膜透析可使患者尽早得到治疗，并且不增加早期导管堵管与渗漏；（2）初期应用小剂量递增式腹膜透析可减少残肾功能的丢失，并维持相对较好的营养状况。（3）与持续标准剂量组比较，小剂量递增式腹膜透析可减少腹膜透析初期透析液的用量。Objective To research and discuss the clinical efficacy of different peritoneal dialysis pattern in end-stage renal disease. Methods By adopting different mode of peritoneal dialysis in patients with end-stage renal disease, patients was divided into two groups random, one is small dose escalation group which dialysate volume is total 4.5-8 L at daytime, the other one is standard dialysis dose group which dialysate volume is total 8 L at all day, compare two groups of nutrition index, biochemical index, dialysis adequacy, residual renal function, Cys-e. Results There were observed statistically significance between the two groups patients of the plasma albumin, 24 hours urine, residual renal function, cys-c （P〈0.05）. There was no statistical significance between the two groups of blood potassium, phosphorus, COzCP, 24 hours ultrafiltration, dialysis adequacy index -weekly total Kt/V, and weekly total Cr clearance （P〉0.05）. After catheter put into the patients within one month, the tube plugging, leakage rate has no statistical significance （P〉0.05）. Conclusion （1） The patients with end-stage renal disease who have good residual renal function can be treated timely with small doses of daytime incremental peritoneal dialysis in the early days, and do not increase the early catheter tube jam and leakage. （2） The small doses of daytime incremental peritoneal dialysis used in the early stage can reduce the loss of residual renal function, maintain a relatively good nutritional status. （3） Compared with standard dialysis dose group, it can reduce the dosage of the peritoneal dialysis in the early stage.

关 键 词：腹膜透析 持续不卧床 小剂量 终末期肾病 

分 类 号：R692.5[医药卫生—泌尿科学]