腹膜透析联合血液透析治疗腹膜透析不充分终末期肾病患者的疗效观察

Observation on the clinical efficacy of peritoneal dialysis combined with hemodialysis in the treatment of end -stage renal disease patients with inadequate peritoneal dialysis

目的探讨腹膜透析联合血液透析（PHD）对腹膜透析不充分终末期肾病患者的治疗效果及其可行性。方法采用自身对照的方法，对15例腹膜透析不充分的终末期肾病患者采用PHD治疗，观察PHD治疗前后临床症状、生化指标、营养状况、并发症等相关指标的变化。结果15例患者PPID治疗后临床症状明显好转。干体重达标率由治疗前的53．33％提高到86．67％（P〈0．05），血红蛋白水平由治疗前的（98．13±7．68）g/L提高到（105．46±5．54）g/L（P〈0．05），血浆白蛋白由治疗前的（37．07±3．41）g/L提高到（40．72±3．24）g／L（P〈0．01），血磷水平由治疗前的（1．85±0．37）mmol／L降至（1．52±0．26）mmol／L（P〈0．05），甲状旁腺素水平降低（P〈0．05）。患者SGA评分中达到A的比例在PHD治疗前后分别为33．3％、60．0％，但差异无统计学意义（P〉0．05）。溶质清除增加，每周尿素Kt／V由治疗前的1，51±0．06增至1．90±0．17（P〈0．01）。结论腹膜透析联合血液透析可以有效改善腹膜透析不充分患者的临床症状，提高透析充分性，最大限度保护患者残余肾功能，减少并发症。

Objective To discuss the therapeutic efficacy and feasibility of peritoneal dialysis combined with hemodialysis （PHD） in the treatment of end -stage renal disease patients with inadequate peritoneal dialysis. Methods A total of 15 end - stage renal disease patients with inadequate peritoneal dialysis were included into the current study and received PHD therapy. Then, their changes in clinical symptoms, biochemical indices, nutritional conditions and compli- cations were observed before and after treatment. Results After PHD therapy, all patients presented improved clinical symptoms. Their percentage of standard dry weight was increased from 53.33% to 86.67% （P 〈0.05）, the level of he- moglobin was increased from （98.13 ±7.68） g/L to （ 105.46 ±5.54） g/L （P 〈0.05）, the level of serum albumin was increased from （37.07 ± 3.41 ） g/L to （40.72± 3.24） g/L （P 〈 0.01 ）. Their level of blood phosphorus was reduced from （ 1.85 ± 0, 37 ） mmol/L to （ 1.52 ±0.26） mmol/L （P 〈 0.05 ）, and the level of parathyroid hormone was klso de- creased （P 〈0.05）. The proportion of A in the SGA scores of the patients was 33.3% before treatment and 60% after treatment, without statistical significance （P 〉0.05）. The weekly Kt/V urea was increased from （1.51 ＋ 0.06） to （ 1.90 ~ 0.17） （ P 〈 0.01 ）. Conclusions PHD therapy can effectively improve the clinical symptoms of patients with inadequate peritoneal dialysis, with better dialysis effectiveness, which then improves patients＇nutritional conditions, pro- tect their residual renal function to the maximum, and reduce their risk of complications.