摘要
目的观察分析不同透析模式对初始透析患者的临床疗效及并发症发生的影响。方法选取本院进行维持性透析(包括血液透析及腹膜透析)3个月的终末期肾病患者86例,其中血液透析(HD)组42例,持续不卧床腹膜透析(CAPD)22例,日间不卧床腹膜透析(DAPD)22例,测定并比较入组9个月3组在尿素清除指数(Kt/V)达标率、24小时尿量、血清白蛋白(Alb)、血红蛋白(Hb)、血钙(Ca)、血磷(P)、血清全段甲状旁腺素(iPTH)水平、水肿、心力衰竭发生率、血压达标率的差异。结果 HD组、CAPD组、DAPD组在Kt/V达标率、Hb水平、心力衰竭发生率方面差异无统计学意义(P>0.05);24h尿量分别为250(142.5)ml、575(387.5)ml、650(150.0)ml,DAPD组尿量最多(P<0.05);Alb分别为(37.7±2.1)g/L、(34.2±1.6)g/L、(36.7±1.4)g/L,HD组最高(P<0.05),DAPD组高于CAPD组(P<0.05);水肿发生率DAPD组最低(P<0.05),分别为50.0%(21/42)、45.5%(10/22)、18.2%(4/22);血压达标率DAPD组最高(P<0.05),分别为45.2%(19/42)、54.5%(12/22)、81.8%(18/22)。HD组、CAPD组、DAPD组血钙分别为(2.25±0.22)mmol/L、(1.94±0.11)mmol/L、(2.01±0.22)mmol/L,HD组高于CAPD及DAPD组(P<0.05)。DAPD组血磷最低(P<0.05),分别为(2.22±0.54)mmol/L、(1.95±0.30)mmol/L、(1.68±0.29)mmol/L,iPTH 3组分别为169.40(241.5)ng/L,137.50(99.5)ng/L,87.50(91.25)ng/L,HD组最高(P<0.05)。结论对于初始进入透析的患者,在3种模式中,DAPD在不影响透析充分性的情况下,能更好的保护残余尿量,更好地控制钙磷代谢及心血管并发症,在Alb优于传统的CAPD,有可能成为残余尿量较好的初始透析患者优选的治疗方式。
Objective To observe and analyze the clinical therapeutic effect and complications of different dialysis modes on initial dialysis patients.Methods Totally 86 patients with end-stage renal disease received maintenant dialysis for 3 months in the hospital were enrolled in this study.The patients included 42 cases of hemodialysis（HD）,22 cases of daytime ambulatory peritoneal dialysis（DAPD） and 22 cases of continuous ambulatory peritoneal dialysis（CAPD）.The success rate of urea clearance index（Kt/V）,24-hour urine output,serum albumin （Alb）,hemoglobin（Hb）,blood calcium,phosphorus,serum segment level of immunoreactive parathyroid hormone （iPTH）,incidence of edema,incidence of heart failure and success rate of blood pressure were detected and analyzed 9 months later.Results There were no statistically significant difference in Kt/V success rate,Hb,and the incidence of heart failure among the three groups （HD,CAPD and DAPD） （P ＞0.05,respectively）.The 24 h urine volume was 250（142.5） ml in HD group,575（387.5） ml in CAPD group and 650（150.0） ml in DAPD group,showing the highest 24 h urine volume in DAPD group （P ＜0.05）.The Alh levels were （37.7 ± 2.1） g/L,（34.2 ± 1.6） g/L and （36.7 ±1.4） g/L in HD,CAPD and DAPD groups,respectively,showing that it was the highest in HD group,and then DAPD group,followed by CAPD group （P ＜0.05）.The success rates of blood pressure were 45.2％ （19/42）,54.5％ （12/22） and 81.8％ （18/22） in HD,CAPD and DAPD groups,respectively,showing the highest in DAPD group （P ＜0.05）.Serum calcium was （2.25±0.22） mmol/L,（1.94±0.11） mmol/L and （2.01±0.22） mmol/L,respectively.Serum calcium was significantly higher in HD group than in the other two groups （P ＜0.05）.Serum phosphorus in HD,CAPD and DAPD groups was （2.22±0.54） mmol/L,（1.95±0.30） mmol/L and （1.68±0.29）mmol/L,respectively.Serum phosphorus was the lowest in DAPD group （P ＜0.05）.iPTH in HD,CAPD and DAPD groups was 169.40 （241.5） ng/L,137.50 （99.5） ng/L and 87.50 （91.25） ng/L,respectively.HD group showed the highest iPTH level （P ＜0.05）.Conclusion For the initial dialysis patients,DAPD dialysis can save the residual urine volume and control the calcium and phosphorus metabolism and cardiovascular-related complications much better without affecting the Kt/V success rate.DAPD is better than the traditional CAPD in Alb.Thus,DAPD may be used as an optimal treatment for the initial dialysis patients with much more urine.
出处
《临床荟萃》
CAS
2014年第10期1171-1174,共4页
Clinical Focus
基金
四川省卫生厅科研基金(120541)
关键词
肾功能衰竭
慢性
肾透析
腹膜透析
kidney failure
chronicity
renal dialysis
peritoneal dialysis
