自动化腹膜透析在住院终末期肾脏病患者中的适用性探讨  

Application of automated peritoneal dialysis for inpatient with end-stage renal disease

作　　者：徐焱 张苗[1] 蒋春明[1] 徐鹏飞 王娟 朱微 XU Yan;ZHANG Miao;JIANG Chunming;XU Pengfei;WANG Juan;ZHU We(Department of Nephrology,Drum Tower Clinical College of Nanjing Medical U-r~iversity/Drum Tower Hospital Affiliated to Medical College of Nanfing U-rtiversity,Nanjing 210008,China)

机构地区：[1]南京医科大学鼓楼临床医学院/南京大学医学院附属鼓楼医院肾内科,江苏南京210008

出　　处：《东南大学学报（医学版）》2018年第4期716-720,共5页Journal of Southeast University(Medical Science Edition)

摘　　要：目的:探讨自动化腹膜透析(automated peritoneal dialysis,APD)用于住院终末期肾脏病患者早期诱导治疗中的疗效和并发症。方法:回顾分析2016年1月至2017年7月53例在本院行院内非计划APD治疗终末期肾脏病患者的临床资料,根据APD治疗模式分为间歇性腹膜透析(intermittent peritoneal dialysis,IPD)和潮式腹膜透析(tidal peritoneal dialysis,TPD)两组进行分析。其中IPD患者30例,TPD患者23例。结果:53例患者共存在64个非计划透析的指征,依次为严重氮质血症、高钾血症、代谢性酸中毒和容量过负荷。经过72 h治疗,无论IPD还是TPD均使严重代谢紊乱得到显著缓解。治疗过程中无死亡病例,无严重并发症发生。透析相关并发症以机器报警和灌注/引流痛最为常见,分别为11例和10例。IPD治疗机器报警和灌注/引流痛发生率分别为33.3%和30.0%,显著高于TPD的4.35%和4.35%(均P<0.05)。患者治疗过程中有2例切口渗漏,1例导管障碍,1例鞘膜积液,两组间发生率差异无统计学意义(P>0.05)。治疗过程中无疝气和腹膜炎发生。结论:APD可安全、有效应用于院内终末期肾脏病患者非计划透析治疗。TPD与IPD相比有较少的机器故障报警和灌注引流痛发生,更适合于住院患者的早期非计划诱导治疗。Objective： To investigate the effectiveness and complications of automated peritoneal dialysis（ APD）for inpatient with end-stage renal disease. Methods： A total of 53 patients with end-stage renal disease initiated unplanned APD treatment in our center were included in this retrospective study. Patients were divided into 2 groups for comparison according to their APD modality as intermittent peritoneal dialysis group（ IPD） and tidal peritoneal dialysis group（ TPD）. Results： There were 64 urgent dialysis indications for all 53 patients. Severe uremia was the most common reason for inpatient＇s unplanned dialysis,followed by hyperkalemia; metabolic acidosis and volume overload. After 72-hour APD treatment,both IPD and TPD were effective in improving the severe abnormal biomarkers and clinical signs and/or symptoms. No patient die during APD treatment. None of severe APD-related complications was observed. The alerts of the cycler and perfusion/drainage pains were the most common complications during treatment,and were seen in 11 and 10 patients respectively. IPD had significantly more alerts of the cycler and perfusion/drainage pains than did TPD（ 33. 3% and 30. 0% vs 4. 35% and 4. 35% respectively,both P〈0. 05）. 2 incision leakage,1 catheter dysfunction and 1 hydrocele testis were observed during APD treatment,and the occurrences of these complications were not significantly different in IPD and TPD patients（ all P〈0. 05）.Conclusion： APD can effectively and safely be used for unplanned peritoneal dialysis patients with end-stage renal disease who should start dialysis soon after catheterization. TPD was more favorable than IPD for fewer alerts and perfusion/drainage pains during the inpatient＇s early-stage APD treatment.

关 键 词：自动化腹膜透析 间歇性腹膜透析 潮式腹膜透析 终末期肾脏病 住院患者 非计划透析 

分 类 号：R692.5[医药卫生—泌尿科学]