适合中国人的理想腹膜透析剂量—6L/d与8L/d的比较  

The ideal peritoneal dialysis dose suitable for Chinese people-comparison between 6L/d and 8L/d

作　　者：王鑫[1] 汪涛[1] 

机构地区：[1]北京大学第一医院肾内科

出　　处：《中国血液净化》2004年第2期68-72,77,共6页Chinese Journal of Blood Purification

基　　金：中华人民共和国教育部长江学者奖励计划;教育部教育振兴行动计划专项基金(985工程)资助

摘　　要：NKF -DOQI推荐 ,持续不卧床腹膜透析 (CAPD)患者适宜的腹膜透析剂量应使总Kt/V至少达到每周 2 .0。而在我国香港 ,患者应用较低的透析剂量 ,预后优于西方国家的患者。目的　探讨适合中国人的理想腹膜透析剂量。方法　利用尿素动力学模型 ,在氮平衡的基础上 ,比较每天透析 6L和 8L的持续不卧床腹膜透析 (CAPD)患者透析充分性的各项判断指标。结果　 2 6例每天透析 6L和 4 5例每天透析 8L的患者参与此项研究。 6L组患者蛋白质摄入 (DPI)和蛋白分解率 (nPCR)分别为 (0 .91± 0 .36 )g/kg/d和 (0 .89± 0 .2 4 )g/kg/d ,处于氮平衡状态 ,实际Kt/V和理论Kt/V无显著差异 ;8L组患者DPI和nPCR分别为 (0 .79± 0 .2 2 )g/kg/d和 (0 .86± 0 .15 )g/kg/d ,处于负氮平衡 ,实际Kt/V高于理论Kt/V。 6L组患者尿量较多 [6L ,(6 35± 5 91)ml/dvs 8L ,(2 6 9± 35 2 )ml/d],而超滤量较少 [(46 3± 5 12 )ml/dvs (86 2± 4 15 )ml/d],但总的体液的排出量 [6L ,(10 98± 5 2 3)ml/dvs 8L ,(1131± 4 5 1)ml/d]没有明显差异。两组患者在高血压、贫血、钙磷代谢紊乱、酸中毒的纠正和生活质量、营养状况等方面均无显著差异。结论　在患者目前的饮食蛋白摄入水平下 ,每天 6L的透析剂量能够满足小分子溶质清除。随着患者残余肾?NKF-DOQI proposed a target Kt/V of 2.0 per week for continuous ambulatory peritoneal dialysis (CAPD). But in Hong Kong,using three 21 dwells daily,a number of investigators have reported patient and technique survival rates superior to those in most western countries. Objective To investigate the ideal peritoneal dialysis dose suitable for Chinese people. Method On the basis of nitrogen kinetic modeling, we compare the adequacy indexes in CAPD patients dialyzed with 6L/d or 8L/d. Results TBZW71 patients (26 in 6L/d, 45 in 8L/d) participated in the study. In 6L group, DPI and nPCR was (0.91±0.36)g/kg/d and (0.89±0.24)g/kg/d respectively, actual Kt/V and theoretic Kt/V is comparable. In 8L group, nPCR(0.86±0.15)g/kg/d significantly higher than DPI(0.79±0.22)g/kg/d and actual Kt/V higher than theoretic Kt/V. Fluid clearance had no difference between the two groups(1098±523)ml/d vs. (1131±451)ml/d. But there was more urine volume[(635±591)ml/d vs (269±352)ml/d] and less ultrafiltration [(463±512)ml/d vs. (862±415)ml/d] in 6L group. There was no difference in the management of hypertension, anemia, hyperphosphatemia, acidosis, quality of life and malnutrition between the two groups. Conclusion Dialysis dose should be individualized according to dietary intake and residual renal function. Three 2L dwells daily is sufficient for small-solute clearance in our patients with their present DPI level. With the vanishing of residual renal function, attention should be paid to prescribe high-tonic dialysate or more dialysis dose to acquire fluid balance.

关 键 词：中国人 腹膜透析 剂量 6L/d 8L/d CAPD 营养学 

分 类 号：R459.5[医药卫生—治疗学]