腹膜透析治疗肝肾综合征的临床疗效观察  

Efficacy of peritoneal dialysis in treatment of hepatorenal syndrome

作　　者：王洪霞[1] 王耀巍 张晶晶[1] 杨丛旭[1] 

机构地区：[1]中国中医科学院西苑医院肾内科,北京100091

出　　处：《生物医学工程与临床》2016年第1期71-75,共5页Biomedical Engineering and Clinical Medicine

摘　　要：目的探讨腹膜透析对肝肾综合征的治疗效果,比较两种透析方式的优劣。方法选取中国中医科学院西苑医院2006年12月至2015年3月符合肝肾综合征的患者20例,其中男性16例,女性4例,平均年龄53.15岁。采用美国Baxter公司生产的腹膜透析管进行腹膜透析治疗,分为置管后立即行持续性非卧床腹膜透析(CAPD)组(A组)9例和间断放腹水组(B组)11例。比较两组治疗前后的近期肝肾功能、尿量、白蛋白变化情况,以及两组患者远期生存时间和腹膜炎发生情况。结果近期疗效,两组患者的尿量在治疗后均显著增加,残肾的尿素清除指数(KT/V治疗前后,A组0.57±0.12 vs 1.24±0.40,B组0.51±0.09 vs 1.30±0.39)、肌酐清除率(Ccr治疗前后,A组11.34±6.32 vs 68.89±16.82,B组10.87±5.56 vs72.32±17.12)均明显改善,两组肾功能均明显恢复,B组白蛋白提高更明显,电解质紊乱得到纠正。远期疗效,两组平均生存时间均达到1.5年,但B组生存时间长于A组(P<0.01)。A组患者的腹膜炎发生率为1/6.43患者月,B组为1/29.80患者月,A组明显高于B组;A组大部分患者在置管半年内发生腹膜炎。结论腹膜透析是缓解肝肾综合征的有效治疗手段,采用先放腹水,再行CAPD的方式似乎更有效。Objective To investigate the effect of peritoneal dialysis in the treatment of hepatorenal syndrome, and compare the efficacy between 2 types of dialysis. Methods From December 2006 to March 2015, a total of 20 patients with hepatorenal syndrome were enrolled, which included 16 males and 4 females with mean age of 53.15 years old. All of the patients performed peritoneal dialysis with intraperitoneal catheter by Baxter Co. All of them were divided into 2 groups, group A（n = 9） treated with continuous ambulatory peritoneal dialysis （CAPD） and group B （n = 11） treated with intraperitoneal catheter to drain ascites persistently. The changes of liver and kidney function, urine volume and albumin＇before and after treatment between 2 groups were compared, long-term survival and peritonitis rate were observed. Results After treatment, urine volumes in 2 groups significantly increased, urea clearance index of residual kidney[KT/V, before and .after treatment in group A（0.57 ± 0.12 vs 1.24 ± 0.40） and group B（0.51±0.09 vs 1.30 ±0.39）], creatinine clearance rate[Ccr, before and after treatment in group A（11.34 ± 6.32 vs 68.89 ± 16.82） and group B （10.87 ± 5.56 vs 72.32 ±17.12）] were significantly improved, the renal function of 2 groups were significantly restored, albumin of group B increased more apparently and electrolyte disorder was corrected. In long-term curative effect, mean survival time reached 1.5 years in 2 groups, but survival time of group B was longer than that of group A（P 〈 0.01）. The peritonitis rates was 1/6,43 in group A and group B of 1/29.80, which was higher than that in group B, and majority patients of group A suffered peritonitis within six-month catheterization. Conclusion It is demonstrated that peritoneal dialysis is the effective treatment of hepatorenal syndrome, which performs CAPD after paracentesis could be more valid.

关 键 词：肝肾综合征 腹膜透析 近期疗效 远期预后 

分 类 号：R575.3[医药卫生—消化系统] R692[医药卫生—内科学]