腹膜透析治疗老年慢性肾功能衰竭的临床分析

目的 分析持续性腹膜透析(PD)治疗老年慢性肾功能衰竭(CRF)患者的临床效果,探讨PD在老年CRF患者中的应用经验.方法 回顾性分析89例老年CRF患者接受PD(简称老年PD组)治疗后的临床表现和生化指标、主要并发症、存活率、死亡原因等,并与53例非老年PD组相比较.结果 老年PD组的原发疾病以糖尿病(37.08%)、原发性高血压(30.34%)为主,而非老年PD组则以肾小球肾炎(54.72%)为主.两组患者的1年与3年存活率差异无统计学意义,腹膜炎仍是两组患者退出PD的主要原因.老年组的病死率明显高于非老年组,感染与心脑血管病是两组患者的主要并发症和死亡原因.低钾血症在老年PD患者中非常普遍.结论 腹膜透析在老年CRF患者的治疗中有效,但长期存活仍受腹膜炎、心脑血管病并发症的影响,老年PD患者的低钾血症应引起足够的重视.     

慢性肾功能衰竭患者腹膜透析后血浆心钠素水平观察

文献报道 ,慢性肾功能衰竭 (ＣＲＦ)患者血浆ＡＮＰ水平随着肾功能恶化有增高趋势 ,血液透析后患者血浆ＡＮＰ水平下降。现将我们对 48例因ＣＲＦ接受持续性非卧床腹膜透析患者测定血浆ＡＮＰ结果报告如下。材料和方法一、对象(一 )正常对照组 :40例 (男 2 1,女 19) ;平均年龄 41.5±12 .6 (2 9～ 5 4)岁 ,经有关检查可排除心、肾、脑疾患。(二 )ＣＲＦ尿毒症期患者 78例 ,分为 2组。 1.ＣＲＦ尿毒症期非透析治疗组 :30例 (男 18,女 12 )平均年龄 46 .5± 12 .5 (34～ 5 9)岁。 2 .ＣＲＦ尿毒症期腹膜透析治疗组 :48例 (男 2 2 ,女2 6 )平均…     

心理护理干预对持续性非卧床腹膜透析慢性肾功能衰竭患者的影响

目的 分析心理护理干预对持续性非卧床腹膜透析慢性肾功能衰竭患者的影响.方法 回顾性分析2013年10月～2014年10月本院收治的102例行CAPD治疗的CRF患者的临床资料,按照随机数字表法分为观察组和对照组,每组51例.对照组予常规护理,观察组在其基础上加强心理护理干预,比较两组心理状态与生活质量.结果 观察组护理后SAS、SDS评分均低于对照组,且生活总体健康(77.53±12.89)分高于对照组的(64.57±10.11)分,差异均具统计学意义(P＜0.05).结论 心理护理干预对持续性非卧床腹膜透析慢性肾功能衰竭患者有积极影响.     

肾移植术前行腹膜透析96例

1　临床资料1.1　一般资料我院 1995 .0 3- 2 0 0 2 .0 8,使用 Tenchhoff氏管行同种异体肾移植术前腹膜透析 96例 ,其中男性 4 5例 ,女性 5 1例 ,年龄 14 - 6 0岁 ,平均年龄 37岁。1.2　方法选择的 Tenchhoff氏管由硅胶组成 ,全长 35 cm,分腹腔、皮下、体外三段。患者仰卧位 ,消毒铺巾后 ,采用脐与耻骨联合中 1/ 3处 ,利多卡因局麻 ,顺序分层切开腹膜 ,用卵圆钳夹持硅胶腹透管前端徐徐送入膀胱直肠陷窝内 (约15 cm) ,管插直后注射肝素盐水 4 0 ml,回抽量相等 ,表示位置适宜 ,然后作荷包缝合采用“单荷包”双扎和皮下置隧道 ,以防漏液与胶透…     

238次肾衰患者腹膜透析植管术回顾分析

目的 探讨肾功能衰竭患者腹膜透析植管术的方法和注意事项，减少并发症的发生率。方法 对230例急、慢性肾功能衰竭患者进行的238次腹膜透析植管术的方法合并症进行回顾性分析。结果 238次腹膜透析植管术中，有37例出现并发症，发生率为15．5％。其中15例（6．3％）合并出口处感染，17例（7．2％）出现非功能性梗阻，3例（1．2％）发生腹股沟疝气，3例（1．2％）发生腹透液满出，1例（0．42％）有涤纶套突出。结论 我们肾病科的腹膜透析植管术方法安全、有效，并发症发生率较低。     

腹膜透析联合血液透析治疗慢性肾衰竭患者的临床价值分析

目的:探讨腹膜透析联合血液透析治疗慢性肾衰竭患者的临床价值.方法:选取2018年4月至2020年4月我院收治的104例慢性肾衰竭患者作为研究对象,随机分为对照组和研究组,各52例.对照组采用腹膜透析治疗,研究组在对照组的基础上联合血液透析治疗.对比两组患者治疗三个月后的临床疗效、肾功能和并发症.结果:研究组总有效率明显...     

慢性肾功能衰竭并发恶性肿瘤的临床分析

目的 通过对慢性肾功能衰竭患者并发恶性肿瘤病例的分析,探讨该类患者的诊断及治疗.方法共选择12例患者,分析其病例及诊治经过.结果 1例经手术病情比较稳定,1例对症治疗后行规律透析存活至今,病情平稳,1例对症治疗后状态较差,其余病例均已死亡.结论 慢性肾衰竭患者恶性肿瘤发病率高,愈后不佳,早发现,早诊断,早治疗是关键.     

浅谈残余肾功能在腹膜透析中的重要作用及保护策略

残余肾功能是影响透析患者生存率和生活质量的重要因素。文章简要阐述了腹膜透析保护残余肾功能的优势、影响残余肾功能的相关因素及残余肾功能的保护策略。     

慢性肾功能衰竭的血液流变性分析

慢性肾功能衰竭的血液流变性分析文／魏国，王莹本文就慢性肾功能衰竭患者的血液流变性检测结果作以分析。１资料与方法１．１临床资料病理组分为２组，第１组有４２例慢性肾功能衰竭（ＣＲＦ）患者，该组患者的血压正常，其中男２８例、女１４例，年龄２０～５４岁；第２...     

利用腹腔引流管行腹膜透析的护理

常规腹膜透析需在腹部行腹透管植入术,我科于1999年3月24日收治一例急性肾功能衰竭、子宫全切术后患者。入院时因病情危重,不宜行血透及腹透管植入术,而利用子宫全切术时,留置的腹腔引流管行不卧床持续性腹膜透析治疗,效果显著。现将病例和腹透析护理体会介绍如下。 一、临床资料 患者,女,22岁,因顺产一男婴后宫腔大出血行子宫全切术后42h,无尿42h伴浮肿、腹胀、消化道出血,从外院转入我科,     

Clinical outcomes and mortality in elderly peritoneal dialysis patients

OBJECTIVES:

To evaluate the clinical outcomes and identify the predictors of mortality in elderly patients undergoing peritoneal dialysis.

METHODS:

We conducted a retrospective study including all incident peritoneal dialysis cases in patients ≥65 years of age treated from 2001 to 2014. Demographic and clinical data on the initiation of peritoneal dialysis and the clinical events during the study period were collected. Infectious complications were recorded. Overall and technique survival rates were analyzed.

RESULTS:

Fifty-eight patients who began peritoneal dialysis during the study period were considered for analysis, and 50 of these patients were included in the final analysis. Peritoneal dialysis exchanges were performed by another person for 65% of the patients, whereas 79.9% of patients preferred to perform the peritoneal dialysis themselves. Peritonitis and catheter exit site/tunnel infection incidences were 20.4±16.3 and 24.6±17.4 patient-months, respectively. During the follow-up period, 40 patients were withdrawn from peritoneal dialysis. Causes of death included peritonitis and/or sepsis (50%) and cardiovascular events (30%). The mean patient survival time was 38.9±4.3 months, and the survival rates were 78.8%, 66.8%, 50.9% and 19.5% at 1, 2, 3 and 4 years after peritoneal dialysis initiation, respectively. Advanced age, the presence of additional diseases, increased episodes of peritonitis, the use of continuous ambulatory peritoneal dialysis, and low albumin levels and daily urine volumes (<100 ml) at the initiation of peritoneal dialysis were predictors of mortality. The mean technique survival duration was 61.7±5.2 months. The technique survival rates were 97.9%, 90.6%, 81.5% and 71% at 1, 2, 3 and 4 years, respectively. None of the factors analyzed were predictors of technique survival.

CONCLUSIONS:

Mortality was higher in elderly patients. Factors affecting mortality in elderly patients included advanced age, the presence of comorbid diseases, increased episodes of peritonitis, use of continuous ambulatory peritoneal dialysis, and low albumin levels and daily urine volumes (<100 ml) at the initiation of peritoneal dialysis.     

不同钙离子浓度的腹膜透析液对腹膜透析患者血清胎球蛋白A水平及动脉粥样硬化的影响

目的 探讨不同Ca2+浓度腹膜透析液对腹膜透析患者血清胎球蛋白A水平和颈动脉粥样硬化的影响,以及两者间的关系.方法 2008年1月至2010年1月本科室收治30例终末期肾病(ESRD)患者,按完全随机法分为生理钙透析液组及普通钙透析液组,分别使用生理钙透析液(Ca2+浓度1.25 mmol/L)和普通钙透析液(Ca2+浓度1.75 mmol/L)进行腹膜透析治疗并随访观察1年.治疗前后检测患者血清高敏C反应蛋白(hs-CRP)、白蛋白(Alb)、甲状旁腺素(PTH)、钙磷乘积(Ca×P)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、胎球蛋白A水平,以及超声检测颈动脉斑块进展情况.10例体检的健康正常人作为健康对照组,检测其血清胎球蛋白A水平.结果 治疗前ESRD组与健康对照组血清胎球蛋白A水平分别为(276.20± 17.0)mg/L和(372.10±18.5)mg/L,ESRD组较健康对照组显著降低(P＜0.01).治疗前胎球蛋白A高水平组患者心血管事件发生率低于胎球蛋白A低水平组(P＜0.05).治疗1年后,生理钙透析液组患者颈动脉斑块进展显著慢于普通钙透析液组(P＜0.05).Logistic回归分析显示颈动脉斑块进展与治疗前后血清胎球蛋白A水平变化值(△fetuin-A)有关联(β=0.320,P＜0.01).结论 生理钙透析液能够通过稳定血清胎球蛋白A水平延缓动脉粥样硬化进展,减少腹膜透析患者心血管事件的发生.     

Protective measures against ultrafiltration failure in peritoneal dialysis patients

Ultrafiltration failure in patients undergoing peritoneal dialysis is a condition with an incidence that increases over time. It is related to increased cardiovascular morbidity and mortality and is a major cause of the abandonment of the treatment technique. Because the number of patients undergoing renal replacement therapy is increasing with society aging and because approximately 10% of this population is treated with peritoneal dialysis, this matter is becoming more common in everyday practice for clinicians involved in the care of patients with chronic renal failure. In this review, we summarize the available measures used to prevent and treat ultrafiltration failure and the current state of research in the field, both in the experimental and clinical settings, focusing on the possible clinical applications of recent findings.     

Liver enzymes in patients with chronic kidney disease undergoing peritoneal dialysis and hemodialysis

OBJECTIVE:

The present study was designed to analyze the serum levels of aspartate and alanine aminotransferases, gamma-glutamyl transferase, and the hematocrit in patients with chronic kidney disease who were undergoing peritoneal dialysis or hemodialysis.

PATIENTS AND METHODS:

Twenty patients on peritoneal dialysis and 40 on hemodialysis were assessed, and the patients were matched according to the length of time that they had been on dialysis. Blood samples were collected (both before and after the session for those on hemodialysis) to measure the enzymes and the hematocrit.

RESULTS:

In the samples from the patients who were undergoing peritoneal dialysis, the aspartate and alanine aminotransferase levels were slightly higher compared with the samples collected from the patients before the hemodialysis session and slightly lower compared with the samples collected after the hemodialysis session. The levels of gamma-glutamyl transferase in the hemodialysis patients were slightly higher than the levels in the patients who were undergoing peritoneal dialysis. In addition, the levels of aminotransferases and gamma-glutamyl transferase that were collected before the hemodialysis session were significantly lower than the values collected after the session. The hematocrit levels were significantly lower in the patients who were on peritoneal dialysis compared with the patients on hemodialysis (both before and after the hemodialysis session), and the levels were also significantly lower before hemodialysis compared with after hemodialysis.

CONCLUSION:

The aminotransferase levels in the patients who were undergoing peritoneal dialysis were slightly higher compared with the samples collected before the hemodialysis session, whereas the aminotransferase levels were slightly lower compared with the samples collected after the session. The hematocrits and the aminotransferase and gamma-glutamyl transferase levels of the samples collected after the hemodialysis session were significantly higher than the samples collected before the session. Taken together, the present data suggest that hemodilution could alter the serum levels of liver enzymes.     

腹膜透析患者透出液透明质酸的变化

目的观察腹膜透析(简称腹透)患者透出液透明质酸(HA)的变化.方法对22例尿毒症腹透患者的透出液采用放射免疫法测定HA水平.结果腹透患者透出液HA较血清HA水平明显增高,分别为(665.79±562.81)μg/L和(336.46±235.32)μg/L(P＜0.05),而层黏连蛋白(LN)和Ⅲ型前胶原(PCⅢ)水平无显著差异;腹透患者透析时间大于3年组较小于3年组的透出液HA水平明显减低,分别为(211.16±73.82)μg/L和(410.10±96.35)μg/L(P＜0.005),而LN和PCⅢ水平无显著差异;腹透患者腹膜炎组透出液HA水平较非腹膜炎组显著增高,分别为(845.12±219.68)μg/L和(303.38±117.27)μg/L(P＜0.005);腹膜炎组透出液LN及PCⅢ也明显增高(P＜0.01).结论测定腹透患者透出液HA水平有助于了解腹膜间皮细胞功能及腹腔状态.     

含糖透析液对慢性腹膜透析大鼠腹膜功能及间皮细胞形态的影响

目的:探讨含糖透析液对慢性大鼠腹膜透析模型腹膜功能和腹膜间皮细胞形态的影响及它们之间的关系。方法:40只SD大鼠随机分为4组,除对照组外,余3组每天分别腹腔内注入20mL4.25%透析液(HG)、1.5%透析液(LG)、林格氏液(RG)。8周后进行腹膜功能试验,并行细胞印片进行形态学分析。结果:HG组及LG组腹腔内透出液量和净出超量明显低于对照组和RG组(P<0.01),4h透析液与血浆尿素氮浓度之比(D/P_urea)显著高于对照组和RG组(P<0.05),尿素氮清除率(C_urea)显著低于对照组和RG组(P<0.01)。细胞印片上HG组及LG组间皮细胞的细胞密度显著少于对照组和RG组,表面积显著大于对照组和RG组(P<0.01)。但以上改变在HG组及LG组间无显著差异。使用含糖透析液8周所致的腹膜超滤功能下降和间皮细胞肥大呈负相关(r=-0.896,P<0.05)。结论:长期应用含糖透析液可使腹膜超滤功能下降,这一作用可能与腹膜间皮细胞肥大有关。     

一种简单的慢性腹膜透析高通透性大鼠模型

腹膜透析是治疗终末期肾脏病的主要手段之一。然而随着透析时间的延长 ,一些患者的腹膜超滤功能可下降 ,通透性增加[1] 。有关研究表明 ,腹膜高通透性是影响患者预后的主要因素之一[2 ,3 ] ,然而 ,腹膜通透性增高的机制目前尚未明确。因此 ,建立腹膜高通透性动物模型将为探讨腹膜通透性增高的机制以及为防治腹膜通透性增高提供有效的研究手段。本文报道了一种简单的腹膜高通透性大鼠模型。材　料　和　方　法1　材料　　Ⅱ级雄性ＳＤ大鼠 ,体重 2 5 0 - 30 0ｇ ,由本校动物中心提供。ＳＮ - 682Ｂ型号计数器 (中国科学院上海原子核研究所日…     

透明质酸在大鼠慢性腹膜透析模型中的作用

目的:了解透明质酸在大鼠慢性腹膜透析中的作用。方法:20只雄性SD大鼠随机分为3组。高糖组(n=8)和透明质酸组(n=6)每天分别腹腔内注射25mL的4.25%葡萄糖腹膜透析液或含0.01%透明质酸(分子量为1600kD)的4.25%葡萄糖腹膜透析液,共7d;正常对照组(n=6),不进行腹腔注射。第8d进行4h腹膜功能实验并于不同时点留取血和腹透液样品进行分析。结果:透明质酸组的腹腔内液容积(IVP)显著高于高糖组(P＜0.01)。高糖组腹腔液体吸收率(K_E)显著高于正常对照组和透明质酸组;高糖组和透明质酸组的淋巴液体吸收率(K_EB)差异无显著性,均显著高于对照组。高糖组的组织间质吸收率(K_ET)显著高于对照组和透明质酸组,后两者区别不明显。结论:在大鼠慢性腹膜透析模型中多次重复使用透明质酸,可以防止由于长期使用以葡萄糖为渗透压制剂的腹膜透析液所引起的腹腔吸收率增加,增加超滤量,保护腹膜功能。     

Agreements between indirect calorimetry and prediction equations of resting energy expenditure in end-stage renal disease patients on continuous ambulatory peritoneal dialysis

Purpose

Equations are frequently used to estimate resting energy expenditure (REE) in a clinical setting. However, few studies have examined their accuracy in end-stage renal disease (ESRD) patients.

Materials and Methods

To investigate agreement between indirect calorimetry and several REE estimating equations in 38 ESRD patients on peritoneal dialysis, we performed indirect calorimetry and compared the results with REEs estimated using 5 equations [Harris-Benedict (HBE), Mifflin, WHO, Schofield, and Cunningham].

Results

Measured REE was 1393.2 ± 238.7 kcal/day. There were no significant differences between measured and estimated REEs except Mifflin (1264.9 ± 224.8 kcal/day). Root mean square errors were smallest for HBE, followed by Schofield, Cunningham, and WHO, and largest for Mifflin (171.3, 171.9, 174.6, 175.3, and 224.6, respectively). In Bland-Altman plot, correlation coefficients between mean values and differences were significant for HBE (r = 0.412, p = 0.012) and tended to be significant for Cunningham (r = 0.283, p = 0.086). In DM patients and patients with overhydration, HBE showed significant underestimation when REE increased.

Conclusion

In ESRD patients on continuous ambulatory peritoneal dialysis (CAPD), REE-estimating equations have no significant differences from indirect calorimetry, except Mifflin. However, HBE showed greater bias than others when REE was high.