腹膜休息对腹膜液体转运功能的影响

Influence of Peritoneal Rest on the Peritoneal Fluid Transport Function

目的研究腹膜休息在持续性不卧床腹膜透析(CAPD)患者中的作用。方法对超滤功能较差的腹透患者,临时改用日间不卧床持续性腹膜透析(DAPD),夜间空腹的透析处方,以使腹膜得到整夜的休息。所有腹膜透析患者都被告知详细记录透析换液,以便评估腹膜静息前后的腹膜流体转运功能。结果本研究入组7例CAPD患者。腹膜休息后的超滤量在存腹3h后较腹膜休息前提高,这种改变在存腹第10h时出现有统计学意义的升高(P<0.05)。患者在腹膜休息前日葡萄糖暴露量、24h透析液/血浆肌酐比值较休息后显著降低(P<0.01或0.05)。腹膜液体吸收率也在腹膜休息后显著降低(P<0.01)。结论腹膜休息可以提高CAPD患者的超滤功能并且降低高渗性透析液的使用。腹膜休息降低了腹膜溶质转运率和腹膜液体重吸收率,使患者的腹膜超滤功能得到恢复。

Objective To explore the effect of peritoneal rest on on peritoneal fluid transport characteristics in patients with continuous ambulatory peritoneal dialysis（CAPD）.Methods A temporary transfer to daytime ambulatory peritoneal dialysis with a nocturnal ＂ empty belly＂ was applied to let the peritoneal membrane rest overnight in patients with poor ultrafiltration capacity.All included patients were asked to record appropriately their dialysis exchanges for the assessment of peritoneal fluid transport characteristics,which were evaluated before and after peritoneal resting.Results Seven CAPD patients were included in the present study.There was a significant improvement in peritoneal ultrafiltration capacity as assessed by ultrafiltration volume per gram of glucose load.Daily glucose exposure and dialysate-to-plasma ratio of creatinine in CAPD patients were significantly decreased after peritoneal resting.The peritoneal fluid absorption rate was also significantly decreased after peritoneal resting（1.011 ± 0.4484） versus（0.625 ± 0.3833） mL.min-1.Conclusion The present study suggests that peritoneal resting can improve ultrafiltration capacity and decrease the use of hypertonic dialysis solution in CAPD patients.The improved ultrafiltration capacity by peritoneal resting was due to decreased membrane solute transport rate and decreased peritoneal fluid absorption rate.