腹膜透析在慢性肾衰伴大量腹水患者中的应用

The effect of peritoneal dialysis on chronic renal failure patients with mass ascites

目的探讨腹膜透析（PD）在慢性肾衰（CRF）伴大量腹水患者中的疗效。方法收集1993—2010年期间CRF伴大量腹水的住院患者25例进行回顾性研究。其中原发病：原发性肾小球肾炎7例,病尿病肾病（DN）5例,狼疮性肾炎（LN）6例,ESRD伴肝硬化4例,CRF伴肾病综合征（NS）2例,肾淀粉样变1例。常规PD植管术,先做好荷包结扎线,再切开腹膜植管结扎。术中放腹水1 000~5 000 ml,根据放腹水的数量补充白蛋白或血浆等。此后酌情行间歇腹膜透析（IPD）或不卧床持续腹膜透析（CAPD）。结果经PD后大多数患者自觉症状明显好转,食欲改善,腹胀、浮肿逐渐消退。25例患者腹部切口均无渗漏腹水。患者透析后Scr、BUN显著下降（P〈0.05）。其中6例（23.08%）患者转为血液透析（HD）（1例PD 5个月后,1例PD 11个月后,1例PD 2年后,3例PD 5年后转为HD）;最长1例患者已存活10年,目前仍在维持性HD中。患者PD后1年内死亡1例,2年及3年后各死亡4例,5年后死亡2例,7年后死亡1例。目前仍在PD5例,失访3例。结论只要做好术前、术中、术后的相应措施,对CRF合并大量腹水的患者进行PD治疗是一种有效、经济、方便的治疗方法。

Objective To evaluate peritoneal dialysis（PD） in patients of chronic renal failure（CRF） with massive ascites.Methods 25 cases of the hospitalized patients with CRF and massive ascites from 1993 to 2010 were analyzed retrospectively.Primary Disease： 7 cases of primary glomerulonephritis,5 patients with diabetic nephropathy（DN）,6 patients with lupus nephritis（LN）,4 cases of end-stage renal disease（ESRD） with liver cirrhosis,2 cases of CRF with nephrotic syndrome（NS）,1 case of renal amyloidosis.Means： PD catheter was routinely implanted.Points： The key procedure was that a pocket should be made before peritoneum cut open,and then implant the catheter.During the course of operation,1000-5000ml ascitic fluid was exuded.After the operation,albumin and/or plasma were supplemented according to volume of ascitic fluid has been exuded.Intermittent peritoneal dialysis（IPD） or continuous ambulatory peritoneal dailysis（CAPD） was applied according to patient＇s condition.Results After the treatment the condition of PD patients were significantly improved,such as appetite,abdominal distention and edema.25 cases of abdominal incision had no leakage of ascites.Dialysis patients with Scr and BUN decreased significantly（P0.05）.6 cases（23.08%） to hemodialysis（HD）（5 months later 1 patient;11 months later 1 patient;2 years later 1 case;5 years later 3 cases）.The patient of the longest period has survived up to 10 years.1 patients of PD died in 1 year after peritoneal dialysis,the death of 4 cases after 2 years,such after 3 years,2 patients died after 5 years,1 patient died after 7 years.5 cases of PD are still,and 3 patients are lost to follow-up.Conclusion If the pre-operation,intra-operation and post-operation were well prepared,PD is effective,economical and convenient treatment for CRF patients with massive ascites.