不同腹膜透析处方的临床疗效观察与分析

Observe Clinical Curative Effect of Different Peritoneal Dialysis Prescription

目的分析比较不同腹膜透析处方的临床疗效。方法横断面回顾性调查分析腹膜透析患者应用不同的腹透处方,根据不同透析剂量处方分为三组:小剂量组<6000m L、中等剂量组6000m L、大剂量组≥8000m L,比较3组的透析充分性、营养状况、钙磷代谢、心血管相关并发症。结果三组患者周尿素清除指数KT/V与周肌酐清除率Ccr无统计学差异(P>0.05),三组患者血磷(P3+)、碱性磷酸酶(ALP)、甲状旁腺素(i PTH)差异均有统计学意义(P<0.05),3组患者血清白蛋白(ALB)比较差异有统计学意义(P<0.05),三组患者血压未达标率、水肿发生率差异有统计学意义(P<0.05),三组患者透析龄、每日透析时间、残肾肌酐清除率(r GFR)、尿量、促红素(EPO)用量差异有统计学意义(P<0.05)。小剂量组体表面积低于大剂量组,差异有统计学意义(P<0.05)。结论 1多数患者腹透早期使用中等剂量能达到透析充分性,并维持较好的营养状态,日间透析的心血管并发症发生率少于持续24小时腹透。2随着透析时间延长,残肾功能逐渐减退,钙磷代谢紊乱及营养不良的状况增加,须调整透析处方来维持透析充分性。3体表面积较小残肾功能较好的患者,透析初期使用相对较少腹透剂量也可达到透析充分性。4个体化腹膜透析处方的患者促红素及透析液的用量相对较少,能节约卫生资源。

Objective Compare the clinical efficacy of different peritoneal dialysis prescription. Methods Analyze dif-ferent peritoneal dialysis prescription by the ways of cross-section and retrospective investigation,divide the peritoneal dialysis pa-tients into three groups according to different dialysis dose prescription:a small dose group <6000mL, medium dose group =6000mL,high-dose group≥8000mL,compare the three groups of dialysis adequacy,nutrition,calcium phosphorus metabolism,car-diovascular related complications. Results Urea clearance index and creatinine clearance of three groups was not statistically sig-nificant(P>0. 05) in one week,while the blood phosphorus,alkaline phosphatase was statistically significant(P<0. 05),as well as parathyroid hormone(iPTH)(P<0. 05),comparison of serum albumin(P<0. 05),the no success rate of blood pressure,inci-dence of edema(P<0. 05),and the age of dialysis,dialysis daily time,volume of urine,rGFR,the dosage of EPO(P<0. 05). Small body surface area of small dose group is lower than the large dose group(P<0. 05). Conclusion ①The majority of patients with end-stage renal disease use medium peritoneal dialysis dose in the early stage can reach dialysis adequacy,and maintain good nutritional status,the incidence of cardiovascular complication of daytime dialysis is less than the group of dialysis for full of 24 hours.②As the dialysis time prolonged,the residual renal function decreased gradually,calcium,phosphorus metabolic disturbance and malnutrition increases,the patients need to increase the dialysis dose for dialysis adequacy.③Patients with better residual re-nal function and smaller surface area also can achieve dialysis adequacy by a relatively small peritoneal dialysis dose.④Individual-ized peritoneal dialysisi can reduce the loss of residual renal function,decease the dosage of EPO and dialysate,thus saving the health resources.