日间非卧床腹膜透析与持续非卧床腹膜透析长期临床疗效观察

目的 比较采用日间非卧床腹膜透析(daytime ambulatory peritoneal dialysis,DAPD)患者与经典持续非卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)患者之间的长期临床疗效,探讨适合中国人的长期腹膜透析(peritoneal dialysis PD)模式.方法 选自海军总医院肾内科行腹膜透析患者32例,随机分成A、B2组,每组16例,A组采用经典的CAPD模式,每天的透析剂量为8L、4次交换、夜间留腹;B组采用DAPD模式,即日间采用8L的透析剂量,每袋透析液交换时间为3～4h,夜间干腹.随后长期监测并比较2组患者的透析充分性,包括尿素清除指数(K t/V(周)、肌酐清除率(Ccr),营养状况包括营养不良发生率(SGA)、血清白蛋白(sALB),并发症控制情况包括血红蛋白(Hb)、二氧化碳结合力(CO2CP)、血钾(K +)、血钙(Ca2+)、血磷(P3- )、游离甲状旁腺激素(iPTH)及血压控制水平(平均动脉压)、腹腔感染率、每组维持透析人数、每组患者维持透析的有效时限(月数)、就业率,采用Barthel指数(BI)进行日常生活能力的评价和汉密尔顿抑郁量表(HAMD)进行抑郁程度的评分,记录患者每天的尿量和超滤量.实验数据以x±s表示,组间均数比较采用方差分析,2组间比较采用t检验或X2检验,P ＜0.05表示差异有统计学意义.结果 A、B2组患者在残余尿量、超滤量、透析充分性[Kt /V(周)、Ccr]、并发症控制中的CO2CP、K +、Ca2+等方面比较差异无统计学意义( P＞ 0.05);B组在营养状况、慢性肾衰竭并发症控制中的Hb、P 3-、iPTH、平均动脉压、腹腔感染率、维持透析人数、透析维持时间、就业率、BI、HAMD等方面均优于A组,差异有统计学意义( P＜0.05).结论 在使用相同透析剂量的情况下,长期行DAPD治疗的患者比经典的CAPD患者在维持透析时间、透析的充分性、营养状况的维护 、并发症的控制、血压的调节、降低腹腔感染率、保持较高的日常生活能力和缓解抑郁程度等方面均有更满意的临床疗效.

Observations on long-term therapeutic efficacy of daytime ambulatory peritoneal dialysis and continuous ambulatory peritoneal dialysis

Objective To compare the long-term therapeutic efficacy in patients with daytime ambulatory peritoneal dialysis(DAPD) and those with traditional continuous ambulatory peritoneal dialysis(CAPD),and to explore the long-term peritoneal dialysis method suitable for Chinese patients.Method A total of 32 outpatients or inpatients subjected to peritoneal dialysis in our hospital were selected and randomized into group A(n=16) and group B(n=16).Patients in group A were treated with CAPD by using the dialysate 8L/day,four exchanges per day,and dialysate left in abdomen cavity at night.Patients in group B were treated with DAPD by using 8L dialysate at daytime,dialysate exchange every 3-4 hours,and evacuation of dialysate from abdomen at night.Long-term monitoring for the patients was carried out.Thoroughness of dialysis was compared between the two groups,including urea clearance index(Kt/V),creatinine clearance rate(Ccr),nutritional status parameters of subjective global assessment(SGA) and serum albumin(sALB),hemoglobin(Hb),carbon dioxide combining power(CO2CP),serum potassium(K+),serum calcium(Ca2+),serum phosphorus(P3-),intact parathyroid hormone(iPTH),mean arterial blood pressure,prevalence of peritoneal infection,number of cases on maintenance dialysis,valid duration(months) of maintenance dialysis,and employment rate.Barthel index(BI) was used for the evaluation of daily life ability,and Hamilton depression rating scale(HAMD) for the evaluation of depression degree.Urinary and ultrafiltration volume were recorded everyday.Data were presented as mean±SD,variance analysis was used for the comparison of mean values,and t-test or X2 test for the comparison between two groups.P<0.05 was considered to be statistically significant.Results Residual urinary volume,ultrafiltration volume,Kt/V(weeks),Ccr,CO2CP,K+,and Ca2+ were statistically insignificant between the two groups(P>0.05).However,nutritional status,Hb,P3-,iPTH,mean arterial blood pressure,prevalence of peritoneal infection,number of cases on maintenance dialysis,valid duration(months) of maintenance dialysis,employment rate,BI,and HAMD were better in group B than in group A(P <0.05).Conclusion Patients under DAPD had better clinical efficacies than those under CAPD in maintenance dialysis duration,thoroughness of dialysis,nutritional status,blood pressure,prevalence of peritoneal infection,daily life ability,and depression degree,although the dialysate volume used was similar in the two groups.