自动化腹膜透析在终末期糖尿病肾病患者中的适用性研究

Observation of the efficacy of automatic peritoneal dialysis in the patients with end-stage diabetic nephropathy

目的观察在终末期糖尿病肾病腹膜透析患者中以夜间间歇性自动化腹膜透析(NIPD)代替普通持续性非卧床腹膜透析(CAPD)的可行性。方法将选取的48例CAPD方案行腹膜透析的患者按照随机数字表法分为观察组及对照组,收集两组患者入院时年龄、性别、体重、腹透时间等基本资料,同时检测并计算患者体重指数,血及腹透液尿素、肌酐,患者收缩压、舒张压、尿量,腹透每日超滤量,血钠、血浆白蛋白,残肾Kt/V,总Kt/V及总肌酐清除率值。然后观察组患者予NIPD模式透析14 d,而对照组予CAPD模式共透析14 d。再次检测并计算上述两组数据,分析两种透析方案在患者中的疗效差别。结果观察组在使用NIPD方案后,在透析容量控制方面,24例入组患者体重指数、收缩压、舒张压、腹透每日超滤量4项的前后对比差异有统计学意义(P<0.05),患者的尿量、血钠及血浆白蛋白在更换透析方案后没有明显统计学差异(P>0.05)。在透析毒素排泄方面,患者血尿素、血肌酐、残肾Kt/V、总Kt/V及总肌酐清除率值无明显统计学差异(P>0.05)。而腹透液尿素及肌酐在更换NIPD后有实际下降,差异有统计学意义(P<0.05)。对照组在持续使用CAPD方案透析后,各项数据前后未有明显变化。结论在终末期糖尿病肾病腹膜透析患者中,NIPD比CAPD在透析容量控制上有明显优势,但在透析毒素清除率上有待进一步的观察及研究。

Objective To evaluate the feasibility of nocturnal intermittent automatic peritoneal dialysis （NIPD） replacing conventional continuous ambulatory peritoneal dialysis（CAPD） in the patients with end-stage diabetic nephropathy. Methods The 48 patients with CAPD were randomly divided into observation group and control group according to random number table method, The age, sex, weight, dialysis time and other basic information of the two groups were collected, at the same time the body mass index of patients, blood and dialysate urea, creatininc, systolic blood pressure, diastolic blood pressure, urine volmne, daily peritoneal uhrafihration volume, blood sodium, plasma albumin, residual kidney Kt/V, total Kt/V and creatinine clearance value were detected and calculated. Then the patients in the observa- tion group were treated with NIPD mode for 14 days, while the control group was treated with CAPD mode for 14 days. The above data were again detected and calculated, and the difference of curative effect between the two regimens before and after the treatment was analyzed. Results by using the NIPD, 24 patients in the observation group＇s BMI, systolic blood pressure, diastolic blood pressure, peritoneal ultrafihration volume before and after contrast has obvious differences on dialysis volume control, was statistical significance（P〈0.05）, and the amount of urine, serum sodium and plasma albumin in the replacement of dialysis program had no significant difference（P〉0.05）. In terms of dialysis toxin excretion,there was no significant difference in serum urea, serum creatinine, residual kidney Kt/V, total Kt/V and total creatinine clearance （P〉0.05）. But the dialysate urea and creatinine was actual declined, the difference was sta tistically significant （P〈0.05）. There was no significant change in the control group before and after the data. Conclusion In patients with end-stage diabetic nephropathy, NIPD has a significant advantage over CAPD in dialysis volume control, but further studies are needed to determine the clearance rate of the toxin.te.