腹膜透析患者充血性心力衰竭的发生与治疗

Occurrence and treatment of congestive heart failure in peritoneal dialysis patients

目的 :探讨腹膜透析 (PD)患者充血性心力衰竭 (CHF)发生的原因及治疗。方法 :选择我院 2 0 0 2年发生CHF的PD患者 10例 ,收集患者从透析开始至发生CHF时的尿量 (UV)和超滤量 (UFV)变化 ,并通过严格限制患者水盐摄入控制CHF ,比较CHF发生时及限制水盐摄入 3个月后体重 (BW )、UV、UFV、2 4h出液量的变化。结果 :发生CHF的PD患者UV和UFV随透析时间的延长而逐渐减少。严格限制水盐摄入 3个月后BW由( 5 8.6 1± 14 .6 2 )kg下降至 ( 5 5 .78± 14 .0 4 )kg( P <0 .0 1) ,CHF的症状改善 ,高渗液体的用量减少。结论 :容量超负荷是PD患者发生CHF的重要原因 。

Objective:To investigate the cause and treatment of CHF in peritoneal dialysis (PD) patients.Methods:Ten PD patients who developed CHF in 2002 were analyzed. Fluid removal that included urine and ultrafiltration volume after the initiation of PD was collected. CHF was controlled by strictly fluid and salt restriction and the patients were closely followed for 3 months.Results:Urine volume and ultrafiltration volume of PD patients decreased with time on PD before the patients developed CHF. After limitting dietary salt and fluid intake for 3 month, patients' body weight decreased significantly from( 58.61 ± 14.62 ) kg to ( 55.78 ± 14.04 ) kg (P< 0.01 ), and the symptoms of CHF improved. The use of hypertonic glucose dialysis solution was also decreased significantly after adopting salt and fluid restriction.Conclusion: Volume overload is an important cause of CHF in PD patients. Dietary fluid and salt restriction is the simple and effective way to prevent and manage CHF in PD patients.