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…     

血液透析和肾移植患者的生存质量比较

目的 对比血液透析（HD）和肾移植（KT）病人现阶段的一般情况、睡眠状况、回归工作的情况和现阶段的生活质量，为临床医生和患者选择替代疗法提供更多有用的信息和依据．方法 对上述2组患者通过门诊、信件及电话追踪等随访方式获得患者现阶段的一般情况、工作情况、平均血红蛋白浓度和现阶段生活质量（SF-36）等资料，进行总结、分析和统计学处理．结果 共获得75例的资料，其中KT组40例，HD组35例；KT组的年龄较HD组组年轻（P=0．001），而在性别、文化程度和原发疾病等方面无差别；KT组的一般情况、回归工作情况、血红蛋白浓度和SF-36量表的6个维度上优于HD组．结论 在生存质量方面，肾移植成功者在整体上优于HD，肾移植是较好的肾脏替代疗法．     

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高于对照组(P<0.05);与治疗前相比,两组治疗后血清尿素氮(Blood Urea Nitrogen,BUN)和血肌酐(Serum Creatinine,Scr)的浓度水平均明显降低(P<0.05),其中研究组BUN和Scr明显低于对照组(P<0.05);研究组并发症发生率明显低于对照组(P<0.05).结论:腹膜透析与血液透析联合治疗慢性肾衰竭疗效确切,可有效改善肾功能,降低并发症发生率,值得临床推广应用.     

血液透析联合腹膜透析对尿毒症患者营养状况的影响

目的:探讨血液透析联合腹膜透析对尿毒症患者营养状况的影响.方法:选取2018年5月至2020年5月我院收治的94例尿毒症患者作为研究对象.所有患者通过随机数字表法分为对照组和联合组,各47例.对照组应用腹膜透析治疗,联合组联合应用腹膜透析、血液透析进行治疗.比较两组并发症发生情况,治疗前后的营养状况、肾功能指标.结果:治疗后两组血红蛋白、白蛋白水平均明显上升,且相比对照组,联合组明显更高(P<0.05).治疗后两组尿素氮、血肌酐水平均明显下降,且相比对照组,联合组明显更低(P<0.05).联合组的并发症发生率为12.77％,高于对照组的8.51％,差异无统计学意义(P>0.05).结论:应用血液透析联合腹膜透析治疗尿毒症患者能够明显改善患者营养状况、肾功能指标,值得推广.     

老年腹膜透析与维持性血液透析患者微炎症状态的比较

目的比较老年腹膜透析与血液透析患者体内微炎症状态的差异。方法选取23例老年腹膜透析及24例维持性血液透析患者,测定并比较两组患者血清高敏C反应蛋白（hs-CRP）、白介素6（IL一6）和肿瘤坏死因子（TNF-α）水平。结果老年腹膜透析患者血清hs-CRP、IL一6和TNF-α水平较维持性血液透析患者低（P〈0.05）。结论老年腹膜透析患者微炎症反应比维持性血液透析患者轻。     

血液透析和肾移植患者的生存质量比较

目的对比血液透析(HD)和肾移植(KT)病人现阶段的一般情况、睡眠状况、回归工作的情况和现阶段的生活质量,为临床医生和患者选择替代疗法提供更多有用的信息和依据.方法对上述2组患者通过门诊、信件及电话追踪等随访方式获得患者现阶段的一般情况、工作情况、平均血红蛋白浓度和现阶段生活质量(SF-36)等资料,进行总结、分析和统计学处理.结果共获得75例的资料,其中KT组40例,HD组35例;KT组的年龄较HD组组年轻(p＝0.001),而在性别、文化程度和原发疾病等方面无差别;KT组的一般情况、回归工作情况、血红蛋白浓度和SF-36量表的6个维度上优于HD组.结论在生存质量方面,肾移植成功者在整体上优于HD,肾移植是较好的肾脏替代疗法.     

分析血液透析和腹膜透析病患钙磷代谢紊乱治疗的临床价值比较

目的 分析血液透析和腹膜透析病患钙磷代谢紊乱治疗的临床价值.方法 将采用血液透析治疗的慢性肾病患者设为对照组,采用腹膜透析治疗的肾病患者为观察组,给予两组患者相同的钙磷代谢紊乱治疗方案.结果 除甲状旁腺激素外,两组患者治疗前的其他血清学指标的差异均无统计学意义,P＞0.05;治疗后,两组血清学指标均有所改善.观察组治疗6个月的碳酸钙片剂量、活性维生素D3剂量明显增加,治疗前后的差异有统计学意义,P＜0.05;但对照组治疗前后的剂量差异无统计学意义,P＞0.05.结论 腹膜透析和血液透析在肾病患者钙磷代谢紊乱治疗中各有优劣,临床应根据患者的实际情况进行选择.     

血液透析和腹膜透析对男性肾性贫血患者睾酮水平和贫血状态的影响

目的:分析血液透析(HD)和腹膜透析(PD)对不同时间终末期肾脏病(ESRD)患者睾酮和肾性贫血的影响。方法:2015-01-01—2016-12-31在本院进行透析治疗患者64例,按其透析方式分为HD组和PD组,各32例,分别比较两组患者透析前、透析3个月、透析6个月后血清总睾酮、游离睾酮和透析前、透析6个月后血红蛋白(Hb)、红细胞计数(RBC)、红细胞比容(Hct)水平变化。结果:透析前两组患者总睾酮、游离睾酮、Hb、RBC、Hct水平均无统计学差异(P0.05),随着透龄增加,PD组患者总睾酮、游离睾酮逐渐增加,PD 3—6个月后显著高于HD组;PD 6个月后患者贫血状态得到有效纠正,其Hb、RBC、Hct升高,明显优于HD组(P0.05)。结论:PD 3个月可明显升高男性ESRD患者血清睾酮水平,纠正肾性贫血,效果优于HD。     

血液透析与腹膜透析对终末期肾病患者血脂、氧化应激及炎症因子的影响

目的分析血液透析与腹膜透析对终末期肾病(ESRD)患者血脂、氧化应激及炎症因子的影响。方法选取2016年1月至2018年1月我院收治的终末期肾病患者200例为研究对象,采用随机数字表法将其分为观察组、对照组各100例,对照组予以血液透析治疗,观察组实施腹膜透析治疗,比较两组治疗前后血脂[总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)]、氧化应激指标[丙二醛(MDA)、髓过氧化物酶(MPO)、超氧化物歧化酶(SOD)]、炎症因子[超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)]水平、生存质量[健康状况调查简表(SF-36)]及并发症的情况。结果治疗后观察组血清TC、TG、HDL-C、LDL-C水平明显低于对照组(P <0.05);治疗后观察组血清MDA、MPO、hs-CRP、TNF-α、IL-6水平低于对照组,而SOD水平高于对照组(P <0.05);治疗3个月、治疗6个月观察组SF-36评分高于对照组(P <0.05);观察组治疗期间并发症发生率12.0%低于对照组24. 0%(P <0.05)。结论与血液透析相比,腹膜透析治疗ESRD疗效更好,可明显改善患者血脂、氧化应激及炎症因子水平,提高其生活质量,减少并发症,值得在临床推广实践。     

湖北地区2501例腹膜透析资料分析

目的:分析湖北地区2 501例腹膜透析(PD)患者的临床特点、透析质量和结局。方法:通过中国血液净化病例登记系统(CNRDS)获取湖北地区截至2016年底共2 501例PD患者资料,分析其年龄、地区分布、原发病、血压及实验室指标血肌酐、血尿素氮、全段甲状旁腺素(iPTH)等水平,同时对PD透程、透析剂量(PDV)、腹膜平衡试验(PET)类型、透析充分性指标及结局进行横断面研究。结果:湖北地区PD患者以41—70岁较多(P0.01),大部分患者集中在武汉市(62.81%),明显多于全省其它地市(P0.01)。PD患者原发病中原发性肾小球肾炎占比高于高血压肾损害和糖尿病肾病等(P0.01);患者透前血尿素氮、血肌酐和iPTH显著升高(P0.01)。2303例患者透程≤48个月,198例48个月;PDV≤8L/天2 353例,8L/天148例;PET类型中高于和低于平均转运者1 942例,高转运(H)和低转运(L)者559例(均P0.01),从而获得较好PD充分性和临床结局。62.42%PD患者每周尿素清除指数(Kt/V)1.7,66.13%PD患者每周肌酐清除率(Ccr)50L/1.73m~2,截至2016年底,继续维持PD者占91.80%,死亡病例占比仅3.68%(均P0.01)。结论:采用PD,对于以原发性肾小球疾病为主导致的尿毒症患者通过不同处方提高透析质量和透析充分性,可有效保护残存肾功能,提高患者生存质量。     

Hypoglycemia in diabetics on dialysis with poor glycemic control: hemodialysis versus continuous ambulatory peritoneal dialysis.

Eight diabetic men with poor glycemic control, probably worsened by severe congestive heart failure and gastroparesis, were sequentially dialyzed by CAPD and hemodialysis. Mean blood glucose concentration, blood glycosylated hemoglobin, and insulin dose were higher during CAPD than during hemodialysis. Among blood glucose determinations, however, the frequency of hypoglycemia (glucose less than 3.3 mmol/L) was higher during hemodialysis (13.2 +/- 8.9%) than during CAPD (2.8 +/- 2.1% p = 0.012), whereas the frequencies of hyperglycemia (glucose greater than 11.1 mmol/L) and euglycemia (glucose between 3.5 and 11.1 mmol/l) did not differ between the two dialysis modalities. Furthermore, hypoglycemia was severe during hemodialysis and was associated with two deaths. There were no deaths linked to abnormalities in blood glucose concentration during CAPD. When hypoglycemia is frequent in diabetics with poor glycemic control, CAPD is preferable to hemodialysis.     

Peritoneal infections in patients on long-term peritoneal dialysis before and after human cadaveric renal transplantation

Long-term peritoneal dialysis was carried out on 38 patients awaiting human cadaveric renal transplantation. Fifty-eight per cent of patients developed infection before transplantation and 41% of those requiring dialysis after transplantation became infected.Infection did not usually occur before the third day of dialysis and 26% of patients developed their first episode of infection in the first week. Almost 50% of patients had only a single episode of infection.The overall rate of infection per 100 patient days of dialysis was 1.23 before transplantation and 4.17 after transplantation.The commonest infecting organisms were Staph aureus and Staph albus and these organisms were frequently isolated from the skin around the dialysis catheter before the infection occurred. Gram-negative infections were more commonly seen after transplantation.Sixty-five per cent of the infections responded to a single course of antibiotic therapy administered in the dialysis fluid. After transplantation Gram-negative infections were usually associated with severe complications and were a major cause of death.Peritoneal dialysis is a convenient way of maintaining patients with chronic renal failure before human cadaveric renal transplantation, and infection, although common is not inevitable, provided precautions are taken to ensure that the dialysis procedure is carried out using aseptic techniques and prophylactic therapy is applied to the skin around the dialysis catheter.     

Dialysis fluids and local host resistance in patients on continuous ambulatory peritoneal dialysis

The ability of polymorphonuclear leukocytes, monocytes and peritoneal macrophages to mount a respiratory burst in continuous ambulatory peritoneal dialysis (CAPD) fluids was tested in a phorbolmyristate acetate stimulated chemiluminescence assay. Fresh CAPD fluids depressed the chemiluminescence response of all three types of phagocytes tested to less than 18% of their chemiluminescence response in control buffer. When tested in spent CAPD fluids the suppression of chemiluminescence was 30–32%. Oxygen consumption of polymorphonuclear leukocytes was depressed in fresh CAPD fluids to below 40%. Both phagocytosis ofEscherichia coli by and bactericidal capacity of polymorphonuclear leukocytes and monocytes were suppressed in fresh CAPD fluids but not in spent effluents. The influence of acidic pH and hyperosmolality on phagocytic functions were studied separately by modifying the acidity or the glucose content of the control buffer. pH values below 6.0 significantly inhibited chemiluminescence but not phagocytosis. Under hypertonic conditions, both phagocytosis and chemiluminescence were inhibited. We conclude that the currently available CAPD solutions are beyond the limits of acid and osmotic tolerance of human phagocytic cells, and may thus compromise the peritoneal defenses of CAPD patients.     

Comparison of risk factors for cardiovascular disease in hemodialysis and peritoneal dialysis patients

OBJECTIVE:

In this study, we aimed to compare the cardiovascular risk factors that might be associated with inflammation, atherosclerosis and metabolic syndrome between hemodialysis and peritoneal dialysis patients.

METHODS:

Fifty hemodialysis and 50 peritoneal dialysis patients who had been receiving dialysis therapy for at least one year were included in the study. Venous blood samples were taken after 12 hours of fasting, and serum glucose, triglyceride, low-density lipoprotein (LDL)-cholesterol, high-density lipoprotein (HDL)-cholesterol, C-reactive protein, fibrinogen and homocysteine levels were measured. The presence of atherosclerotic plaques in the carotid artery was evaluated by carotid Doppler ultrasound. These data were analyzed by Student''s t test, the chi-square test and the Mann-Whitney U test, as appropriate.

RESULTS:

No difference was found between the hemodialysis (n=50) and peritoneal dialysis (n=50) patient groups regarding mean age, gender distribution, body mass index or dialysis duration (p=0.269, 0.683, 0.426, and 0.052, respectively). LDL-cholesterol, fibrinogen and homocysteine levels were significantly higher in peritoneal dialysis patients (p=0.006, 0.001, and 0.002, respectively). In patients with diabetes mellitus (n=17) who were undergoing renal replacement therapy, LDL-cholesterol and fibrinogen levels were significantly higher than in patients without diabetes mellitus who were undergoing renal replacement therapy (p=0.001 and 0.004, respectively).

CONCLUSION:

In our study, cardiovascular risk factors (especially LDL-cholesterol) were more frequent in peritoneal dialysis patients than in hemodialysis patients.     

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.