自动化腹膜透析在住院终末期肾脏病患者中的适用性探讨-东南大学学报医学版

自动化腹膜透析在住院终末期肾脏病患者中的适用性探讨

单位：南京医科大学鼓楼临床医学院/南京大学医学院附属鼓楼医院肾内科, 江苏南京 210008

分类号：R692.5

出版年·卷·期（页码）：2018·37·第四期（716-720）

摘要：

目的：探讨自动化腹膜透析（automated peritoneal dialysis，APD）用于住院终末期肾脏病患者早期诱导治疗中的疗效和并发症。方法：回顾分析2016年1月至2017年7月53例在本院行院内非计划APD治疗终末期肾脏病患者的临床资料，根据APD治疗模式分为间歇性腹膜透析（intermittent peritoneal dialysis，IPD）和潮式腹膜透析（tidal peritoneal dialysis，TPD）两组进行分析。其中IPD患者30例，TPD患者23例。结果：53例患者共存在64个非计划透析的指征，依次为严重氮质血症、高钾血症、代谢性酸中毒和容量过负荷。经过72 h治疗，无论IPD还是TPD均使严重代谢紊乱得到显著缓解。治疗过程中无死亡病例，无严重并发症发生。透析相关并发症以机器报警和灌注/引流痛最为常见，分别为11例和10例。IPD治疗机器报警和灌注/引流痛发生率分别为33.3%和30.0%，显著高于TPD的4.35%和4.35%（均P<0.05）。患者治疗过程中有2例切口渗漏，1例导管障碍，1例鞘膜积液，两组间发生率差异无统计学意义（P>0.05）。治疗过程中无疝气和腹膜炎发生。结论：APD可安全、有效应用于院内终末期肾脏病患者非计划透析治疗。TPD与IPD相比有较少的机器故障报警和灌注引流痛发生，更适合于住院患者的早期非计划诱导治疗。

Objective:To investigate the effectiveness and complications of automated peritoneal dialysis (APD) for inpatient with end-stage renal disease. Methods:A total of 53 patients with end-stage renal disease initiated unplanned APD treatment in our center were included in this retrospective study. Patients were divided into 2 groups for comparison according to their APD modality as intermittent peritoneal dialysis group (IPD) and tidal peritoneal dialysis group (TPD). Results:There were 64 urgent dialysis indications for all 53 patients. Severe uremia was the most common reason for inpatient's unplanned dialysis, followed by hyperkalemia; metabolic acidosis and volume overload. After 72-hour APD treatment, both IPD and TPD were effective in improving the severe abnormal biomarkers and clinical signs and/or symptoms. No patient die during APD treatment. None of severe APD-related complications was observed. The alerts of the cycler and perfusion/drainage pains were the most common complications during treatment, and were seen in 11 and 10 patients respectively. IPD had significantly more alerts of the cycler and perfusion/drainage pains than did TPD (33.3% and 30.0% vs 4.35% and 4.35% respectively, both P<0.05). 2 incision leakage, 1 catheter dysfunction and 1 hydrocele testis were observed during APD treatment, and the occurrences of these complications were not significantly different in IPD and TPD patients(all P>0.05). Conclusion:APD can effectively and safely be used for unplanned peritoneal dialysis patients with end-stage renal disease who should start dialysis soon after catheterization. TPD was more favorable than IPD for fewer alerts and perfusion/drainage pains during the inpatient's early-stage APD treatment.

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