自动化腹膜透析在住院强化透析患者中的适用性探讨

The application of automated peritoneal dialysis to inpatients requiring intensive dialysis therapy

目的探讨自动化腹膜透析(automated peritoneal dialysis,APD)应用于住院患者强化治疗中的疗效和并发症。方法回顾分析2016年1月~2017年12月间28例在南京医科大学鼓楼临床医学院肾内科行院内强化APD治疗患者的临床资料,根据APD治疗模式分为间歇性腹膜透析(intermittent peritoneal dialysis,IPD)和潮式腹膜透析(tidal peritoneal dialysis,TPD)2组进行观察。其中,IPD患者19例,TPD患者9例。结果 28例患者共存在40个非计划透析的指征,依次为容量过负荷(IPD组12例、TPD组5例)、高钾血症(IPD、TPD组各5例)、严重氮质血症(IPD组4例,TPD组2例)、代谢性酸中毒(IPD组3例,TPD组1例)和外科术前准备(IPD组2例,TPD组1例)。经过72h治疗,2组中容量过负荷患者治疗前后相比体质量、血清B型尿钠肽、纽约心功能分级(New York heart association,NYHA)、血钾变化显著(IPD组t值分别为21.040,20.069,9.950,23.724;P值分别为<0.001,<0.001,<0.001,<0.001;TPD组t值分别为7.785,11.068,6.832,10.424;P值分别为0.001,<0.001,0.003,<0.001);有消化道症状患者(IPD组10例,TPD组7例)治疗后消化道症状显著改善,微型营养评定简表(mini nutritional assessment,MNA)评分改善(t值分别为:-27.000,-16.202;P值分别为<0.001,<0.001);治疗过程中,无死亡病例。无透析相关并发症如机器报警、灌注/引流痛、切口渗漏、导管障碍、睾丸鞘膜积液和疝气发生。结论 APD可安全、有效应用于院内强化透析治疗。

Objective To investigate the effectiveness and complications of automated peritoneal dialysis(APD) in inpatients requiring intensive dialysis therapy. Methods A total of 28 patients undergoing intensive APD treatment in the Nephrology Department of Drum Tower Clinical College of Nanjing Medical University from January 2016 to December 2017 were included in this retrospective study. Patients were divided into intermittent peritoneal dialysis group(IPD;n=19) and tidal peritoneal dialysis group(TPD;n=9) according to the APD modality. Results There were 40 intensive dialysis indications in the 28 APD patients;volume overload(12 cases in IPD group and 5 cases in TPD group) was the most common indication for intensive dialysis in these patients, followed by hyperkalemia(5 cases in IPD group and 5 cases in TPD group), severe azotemia(4 cases in IPD group and 2 cases in TPD group), metabolic acidosis(3 cases in IPD group and one case in TPD group) and preoperative preparation(2 cases in IPD group and one case in TPD group). After APD treatment for 72 hours, body weight, type B natriuretic peptide, New York Heart Association(NYHA)heart function classification and serum potassium changed significantly(for IPD group: t=21.040, 20.069,9.950 and 23.724 respectively, P<0.001;for TPD group: t=7.785, 11.068, 6.832 and 10.424 respectively, P=0.001, <0.001, 0.003 and <0.001 respectively) in volume overload patients in both groups;gastrointestinal symptoms and mini nutritional assessment(MNA) score improved significantly(t=-27.000 and-16.202 respectively, P<0.001) in patients with gastrointestinal symptoms(10 cases in IPD group and 7 cases in TPD group). No severe complications and no death of the patients occurred during the APD treatment. APD-related complications such as alerts of the cycler, perfusion/drainage pain, incision leakage;catheter dysfunction, hydrocele testis and hernia were not found. Conclusion APD can effectively and safely be used for intensive peritoneal dialysis patients who need to receive short-term and high dose dialysis treatment.