早期日间非卧床腹膜透析在终末期肾病治疗中的优势探讨  

Advantages of early daytime ambulatory peritoneal dialysis in treatment of end-stage renal disease

作　　者：何振坤[1] 白彝华[1] 蒋红樱[1] 杨敏[1] 廖云娟[1] 连希艳[1] Zhen-kun He;Yi-hua Bai;Hong-ying Jiang;Min Yang;Yun-juan Liao;Xi-yan Lian(Department of Nephropathy, the Second Affiliated Hospital of Kunming Medical University,Kunming, Yunnan 650101, China)

机构地区：[1]昆明医科大学第二附属医院肾脏内科,云南昆明650101

出　　处：《中国现代医学杂志》2018年第1期67-73,共7页China Journal of Modern Medicine

基　　金：云南省教育厅科学研究基金项目(No:2015Y152)

摘　　要：目的探讨早期日间非卧床腹膜透析在终末期肾病治疗中的优势。方法纳入84例初始腹膜透析患者,随机分为两组:日间非卧床腹膜透析(DAPD)组(n=40):接受日间非卧床腹膜透析;持续不卧床腹膜透析(CAPD)组(n=44):接受持续不卧床腹膜透析。两组均继续接受常规药物治疗。随访24个月,全部患者每6个月监测钙、磷及甲状旁腺激素等指标,记录尿量、透析剂量、透析效能和残余肾功能的变化。结果两组患者低钙、高磷血症较治疗前有所纠正,差异有统计学意义(P<0.01),24个月时DAPD组血磷水平与CAPD组比较,差异有统计学意义(P<0.05),DAPD组低于CAPD组。CAPD组治疗早期甲状旁腺激素水平与DAPD组比较,差异有统计学意义(P<0.05),CAPD组低于DAPD组,但18个月后差异无统计学意义(P>0.05)。两组患者尿量及残余肾功能均随着治疗延续而逐渐下降,12个月后CAPD组低于DAPD组。DAPD组12个月后残余肾尿素清除指数(Kt/V)高于CAPD组,18个月后腹透液剂量低于CAPD组。结论早期DAPD能较好地改善患者钙磷代谢紊乱。DAPD对残余肾功能保护较好,残余肾Kt/V较高,使用腹透液剂量较少。Objective To explore the advantages of early daytime ambulatory peritoneal dialysis in treatment of end-stage renal disease.Methods Eighty-four cases of initial peritoneal dialysis patients were randomly divided into two groups.The patients in the DAPD group(40cases)received daytime ambulatory peritoneal dialysis;those in the CAPD group(44cases)received continuous ambulatory peritoneal dialysis.Both groups continued to receive conventional drug therapy,and followed up for24months.In all patients calcium,phosphorus and parathyroid hormone were monitored;and urine volume,peritoneal dialysis volume,dialysis efficacy and residual renal function were recorded every six months.Results In both groups,hypocalcemia and hyperphosphatemia were improved after peritoneal dialysis(P<0.05).After24months,the blood phosphorus level of the DAPD group was lower than that of the CAPD group(P<0.05).In the early period,the parathyroid hormone level of the CAPD group was lower than that of the DAPD group(P<0.05),but the difference was not significant after18months(P>0.05).The urine volume and residual renal function decreased gradually in both groups,and they were lower in the CAPD group than in the DAPD group after12months(P<0.05).The residual renal Kt/V in the DAPD group was higher than that in the CAPD group12months later(P<0.05).The volume of peritoneal dialysis fluid in the DAPD group was smallerthan that in the CAPD group12months later(P<0.05).Conclusions Early daytime ambulatory peritoneal dialysis can improve the status of calcium-phosphate metabolism.Daytime ambulatory peritoneal dialysis can protect the residual renal function,maintain higher residual renal Kt/V,and use less peritoneal dialysis fluid.

关 键 词：日间非卧床腹膜透析 持续不卧床腹膜透析 钙磷代谢 残余肾功能 

分 类 号：R459.5[医药卫生—治疗学]