腹膜透析患者腹腔压力测量装置设计与应用

Design and application of intra-abdominal pressure measuring device for peritoneal dialysis patients

目的:设计一种可重复使用、连续多次测量腹膜透析(PD)患者腹腔内压力的装置,并评估该装置测量准确性及在成人腹膜透析患者中应用的可行性与安全性。方法:设计的腹腔压力(IPP)测量装置由U型压力计、带有夹子的塑料软管和空气压力传感器保护器组成,该装置通过医用延长管和医用三通装置连接PD外接管及双联PD液袋,转动三通装置实现透析液的定量注入和IPP的测量。将IPP测量装置测压端口连接水银血压计及心电监护仪有创血压测量端,判断其测压准确性。研究对象来自2022年10月至2023年2月在东南大学附属中大医院肾内科行住院腹膜透析治疗或者门诊随访且透析龄≥1周的患者,收集入选者人口学及临床资料。在患者平静呼吸状态下使用腹腔测压装置测量不同灌入量下、不同体位的IPP。记录不同剂量、不同体位患者的腹腔压力值,测量过程中疼痛、腹胀等症状发生率、IPP测量后压力相关并发症及感染情况,随访PD患者IPP测量后3月的结局。以组内相关系数评价两种测压法的一致性,采用散点图和Spearman相关分析法分析IPP与灌注量的相关性。结果:心电监护仪压力数值和水银血压计压力测量数值相差无几,U型管压力计转换后压力数值与水银压力数值一致性好,信度高(ICC=0.997,P<0.001)、本研究纳入51例患者,测量结果发现同一体位下,腹腔压力随着透析液灌入量增加而升高,同一灌入量下,腹腔压力值直立位>坐位>卧位;三种不同体位下腹腔压力增加值与PD灌注增加量呈正相关(卧位:r=0.777,P<0.001;坐位:r=0.809,P<0.001;直立位:r=0.740,P<0.001);有1例患者在测压过程中出现肩背部一过性轻度疼痛,其余患者测量过程中均无不适反应,无腹膜炎症状与体征。观察1月后,51例患者均未发生与测压相关的腹膜炎及压力相关腹壁疝等临床表现。结论:本装置测量准确、使用过程安全,可以重复使用、连续多次测量患者腹腔内压力,对PD患者临床透析处方制定有指导意义。

Objective:To design a reusable device for continuous multiple measurement of intraperitoneal pressure in peritoneal dialysis patients,and to evaluate the feasibility and safety of the application of the method.Methodology:The designed measuring device is composed of a U-shaped pressure gauge,a plastic hose with clamps and an air pressure sensor protector.The device is connected to the external pipe of abdominal dialysis and the double bag of abdominal dialysis liquid through the medical extension pipe and the medical three-way stopcock.The three-way stopcock is rotated to realize the quantitative injection of abdominal dialysis liquid and the measurement of abdominal pressure.The pressure measuring port of the device was connected to the invasive blood pressure measuring terminal of the mercury sphygmomanometer and the ECG monitor to judge the accuracy.The subjects were enrolled from October 2022 to February 2023 patients who underwent in-patient peritoneal dialysis or outpatient follow-up in the Department of Nephrology of a third-class A hospital in Nanjing and were dialysis age≥1 week.The patient's demographic and clinical information were collected.Record the abdominal pressure values of patients with different doses and different positions,measure the incidence of symptoms such as pain and abdominal distension,pressure-related complications and infections after intra-abdominal pressure.Follow up outcomes 3 months after intra-abdominal pressure measurement.The consistency of the two manometry methods was evaluated by intra-group correlation coefficient.A scatter plot and Spearman correlation test were used to explore the correlation between fill volumes and the intraperitoneal pressure.Results:The pressure value of the ECG monitor is almost the same as that of the mercury sphygmomanometer.The pressure value of the U-shaped pressure gauge after conversion is in good consistency with that of the mercury pressure with high reliability(ICC=0.997,P<0.001).Fifty-one patients were included in this study,and the measurement results showed that the abdominal pressure increased with the increase of the amount of peritoneal dialysis fluid in the same body position.Under the same amount of peritoneal dialysis fluid,the abdominal pressure value was in upright position sitting position lying position.The increase of abdominal pressure was positively correlated with the increase of peritoneal perfusion in three different postures(decubitus:r=0.777,P<0.001;Sitting position:r=0.809,P<0.001;Upright position:r=0.740,P<0.001).1 patient showed transient mild pain in the shoulder and back during the manometry,while the rest patients showed no discomfort and no signs and symptoms of peritonitis during the measurement.After one month of observation,none of the 51 patients developed manometry related peritonitis and pressure related abdominal hernia.Conclusion:This device has accurate measurement and safe use process,and can be reused and measured intra-abdominal pressure,which is instructive for the formulation of clinical dialysis prescription in patients with abdominal dialysis.