自动化腹膜透析治疗持续不卧床腹膜透析并发心力衰竭患者的临床观察  

Clinical observation of treatment of CAPD with heart failure by APD

作　　者：史春夏 李妍 史亚男 蔡佳杰 李忠心[1] SHI Chun-xia;LI Yan;SHI Ya-nan;CAI Jia-jie;LI Zhong-xin(Department of Nephrology,Beijing Luhe Hospital Affiliated to Capital Medical University,Beijing 101149,China)

机构地区：[1]首都医科大学附属潞河医院肾内科,北京101149

出　　处：《中国血液净化》2020年第2期99-102,共4页Chinese Journal of Blood Purification

基　　金：北京市通州区科学技术委员会基金(KJ2019CX012-36)。

摘　　要：目的探讨应用自动化腹膜透析(automated peritoneal dialysis,APD)治疗持续不卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)患者出现心力衰竭(heart failure,HF)的治疗效果。方法本研究自2016年8月1日~2018年7月31日共纳入44例患者。所有患者在入院前接受CAPD治疗期间出现HF,并在住院后接受APD治疗。记录治疗前及治疗后患者腹膜透析超滤量、尿量、体质量、血压、血清学指标及HF分级(NYHA分级)等。结果44例腹膜透析患者,APD治疗4日后24h超滤量与CAPD时相比显著增加(t=-15.448,P<0.001),接受APD治疗4日后LHF水平显著降低(Z=-7.582,P<0.001),APD治疗4日后体质量明显下降(t=11.411,P<0.001)。APD治疗4日后血压控制良好(收缩压t=11.713,P<0.001;舒张压t=8.407,P<0.001)。APD治疗4日后患者血肌酐、血尿素氮、NTproBNP均显著低于治疗前,差异有统计学意义(t值分别为7.891,7.952,1.142;P值分别为<0.001,<0.001,<0.001)。结论CAPD患者易合并容量超负荷引起的心力衰竭,APD可增加超滤、快速缓解心力衰竭患者的症状、改善心功能分级,降低血肌酐、血尿素氮、收缩压,可作为CAPD患者出现心力衰竭的有效方法。Objective To study the effect of APD on Heart failure(HF)in CAPD patients.Methods 44 patients were included in this study from August 1,2016 to July 31,2018.All patients had been treated with CAPD before they came to our center and were treated with APD in the hospital.The ultrafiltration volume,urine volume,body mass,blood pressure,serological index and HF grade(NYHA grade)were recorded before and after treatment.Results Of the 44 patients,peritoneal dialysis UF was significantly increased when receiving APD compared to CAPD(t=-15.448,P<0.001),and LHF class was significantly decreased 4 days after receiving APD(Z=-7.582,P<0.001).Body weights had significantly decreased 4 days after treatment with APD(t=11.411,P<0.001).Blood pressure was well controlled 4 days after treatment with APD(SBP11.713,P<0.001;DBP t=8.407,P<0.001).After 4 days of APD treatment,serum creatinine,BUN and NTproBNP levels were significantly lower than those before treatment,and the difference was statistically significant(t=7.891,P<0.001).Conclusions CAPD patients is easily associated with heart failure caused by volume overload,APD can effectively improve the acute heart failure symptoms,improve LHF,increase the ultrafiltration,and reduce serum creatinine,blood urea nitrogen,systolic blood pressure.It may be an effective way to treat CAPD patients with heart failure.

关 键 词：自动化腹膜透析 持续不卧床腹膜透析 心力衰竭 

分 类 号：R459.5[医药卫生—治疗学]