持续非卧床腹膜透析腹膜功能减退影响因素和干预策略

Influencing factors and interventions for the deterioration of peritoneal function in continuous ambulatory peritoneal dialysis patients

随着腹膜透析龄的不断延长,患者腹膜功能将逐渐减退,表现为对溶质转运加快,水分超滤逐渐减少,直至发生超滤衰竭;一旦发生超滤衰竭,将直接导致腹膜透析失败。腹膜炎、生物不相容透析液、残余肾功能、长透析龄是腹膜功能减退的影响因素。腹膜平衡试验是目前评价腹膜功能最常用的方法,但应结合临床动态分析。规范防治腹膜炎、制定合理的透析处方、保护残余肾功能、应用新型透析液等是保护腹膜功能切实有效的干预策略。

In patients on peritoneal dialysis, the peritoneal function deteriorated with the prolonged dialysis time, characterized by the acceleration in solute transportation, decrease in fluid ultra-filtration and progeression into ultra-filtration failure in the end stage. The ultra-filtration failure is the direct cause of the failure of peritoneal dialysis. The influencing factors include peritonitis, bio-incompatible peritoneal dialysis solutions, residual renal function and long time of dialysis. Peritoneal equilibration test is commonly used in evaluation of the peritoneal function, of which the results should be interpreted with the clinical conditions. Standardized prevention and treatment of peritonitis, proper dialysis prescriptions, reservation of residual renal function, application of novel dialysate may be effective strategies in protecting peritoneal function.