不同体质指数腹膜透析患者应用自动化腹膜透析强化治疗对比研究

A comparative study on the application of automatic peritoneal dialysis intensive patients with different body mass indexes

目的比较自动化腹膜透析(automatic peritoneal dialysis,APD)对不同体质指数(body mass index,BMI)腹膜透析患者过渡性治疗的效果差异。方法纳入宁夏医科大学总医院腹膜透析中心2007年1月至2016年12月期间应用APD治疗维持性腹膜透析合并慢性并发症的患者126例,根据BMI分为低BMI组、正常BMI组、高BMI组。比较各组治疗前后指标变化及临床改善情况。结果不同BMI组患者单个循环透析液平均葡萄糖浓度、每24 h每单位体重透析剂量、末次循环液量组间比较差异有统计学意义(P<0.05)。低BMI组和正常BMI组患者血肌酐水平治疗后下降(P<0.05);低BMI组、高BMI组血尿素水平治疗后下降(P<0.05)。治疗后三组患者的尿素清除指数(Kt/V)及总肌酐清除率(TCcr)较治疗前显著提高(P<0.05),但治疗后三组间比较差异无统计学意义(P>0.05)。经APD过渡治疗后,三组患者的临床症状均有所缓解,治疗后的临床症状评分明显低于治疗前,其中低BMI组、正常BMI组较高BMI组下降明显(P<0.05)。结论对于不同BMI的腹膜透析患者,借助APD过渡性治疗能在短期内强化毒素和水分清除,不同程度地缓解慢性并发症。制定APD处方时BMI应作为调整因素加以考虑。

Objective To compare the effect of automated peritoneal dialysis(APD)on transitional treatment of peritoneal dialysis patients with different body mass index(BMI). Methods A total of 126 patients on maintenance peritoneal dialysis with APD combined with chronic complications were in cluded,who received treatment in the peritoneal dialysis center of General Hospital of Ningxia Medical University from January 2007 to December 2016. According to the BMI of patients,they were divided into three groups: low BMI group,normal BMI group and high BMI group. Compare the index changes and clinical improvement before and after treatment in each group. Results There were significant differences in the average glucose concentration,dialysis dose per kilogram of body weight per 24 hours,and the last circulating fluid among different BMI groups(P<0.05). The blood creatinine level in low-BMI group and normal-BMI group decreased after treatment(P<0.05);blood urea level in low-BMI group and high-BMI group decreased after treatment(P<0.05). After treatment,the Kt/V and total Ccr of the three groups were increased compared with those before treatment(P<0.05),but there were no statistical differences amone the 3 groups(P>0.05). After APD transition treatment,the clinical symptoms of the three groups were relieved,the symptom score after treatment was significantly lower than that before treatment,and the decrease in low-BMI group and houmal-BMI group was more significant than in high-BMI(P<0.05). Conclusion For peritoneal dialysis patients with different body mass index, APD transitional treatment can strengthen toxin and water removal in the short term and alleviate chronic complications to varying degrees. The APD prescription without distinguishing BMI may be have a certain influence on the treatment effect of patients with large body mass.