CAPD透出液蛋白质丢失情况分析

ＣＡＰＤ透出液蛋白质丢失情况分析大连医科大学附属第二医院（１１６０２３）高庆荫，冯晓海，于志红持续性不卧床腹膜透析（ＣＡＰＤ）是治疗尿毒症的主要措施之一，但腹膜透析迄今尚存在腹膜感染和蛋白质丢失问题。本文测定了１０例ＣＡＰＤ患者透出液蛋白质总量和不同...     

CAPD患者蛋白质丢失与腹透时间、PET与KT／Vurea的关系

对16例新透析患者（透析时间在30d）和透析时间＞1年的19例患者蛋白质丢失与渐近时间、腹膜平衡试验（PET）及尿素清除指数（KT／Vurea ）关系进行了分析。结果发现：两组患者腹膜透液中,蛋白质丢失量比较差异无显著性（P＞0．05）。在PETD／Pcr值≥0．65患者腹透液中,蛋白质丢失量与PET D／Pcr值＜0．65患者比较差异无显著性（P＞0．05）。尿素清除指数（KT／Vurea）≥2．0与KT／Vurea＜2．0患者腹透液中蛋白质丢失量比较亦无无统计学意义（P＞0．05）。提示,常规CAPD无腹膜炎患者腹透液中蛋白质丢失量与透析时间,小分子溶质转运,透析是否充分无相关性;进一步支持大分子蛋白质转运与小分子溶质转运可能为不同途径。     

CAPD患者蛋白质丢失与腹透时间、PET及KT/Vurea的关系

对 16例新透析患者 (透析时间在 30d)和透析时间 >1年的 19例患者蛋白质丢失与透析时间、腹膜平衡试验 (PET)及尿素清除指数 (KT/Vurea)关系进行了分析。结果发现 :两组患者腹透液中 ,蛋白质丢失量比较差异无显著性 (P >0 .0 5 )。在PETD/Pcr值≥ 0 6 5患者腹透液中 ,蛋白质丢失量与PETD/Pcr值 <0 .6 5患者比较差异无显著性(P >0 .0 5 )。尿素清除指数 (KT/Vurea)≥ 2 0与KT/Vurea<2 0患者腹透液中蛋白质丢失量比较亦无统计学意义 (P >0 .0 5 )。提示 ,常规CAPD无腹膜炎患者腹透液中蛋白质丢失量与透析时间 ,小分子溶质转运 ,透析是否充分无相关性 ;进一步支持大分子蛋白质转运与小分子溶质转运可能为不同途径     

丹参对腹膜透析溶质转运的影响

将丹参注射液以６‰的浓度加至腹透液中，观察ＣＡＰＤ病人ＢＵＮ，Ｃｒ，总蛋白Ｄ／Ｐ值的变化及葡萄糖Ｄ／Ｄ０值及引流量的变化。结果发现：从加入丹参第二天开始ＢＵＮ，Ｃｒ，Ｄ／Ｐ值增加，葡萄糖Ｄ／Ｄ０值第１天明显增加，第二天回到对照值；蛋白质加入丹参第１天开始持续增加，而引流量并无改变。     

腹膜电荷屏障与CAPD患者腹透液蛋白质丢失的关系

持续非卧床腹膜透析(CAPD)是尿毒症的肾脏替代治疗方式之一,在腹膜透析过程中蛋白质丢失是造成CAPD患者蛋白质营养不良的一个重要因素。文献报道每天自透析液中丢失的蛋白质多达10.5g左右,其中多为白蛋白。     

丹参对腹膜透析溶质转运的影响

将丹参注射液以６‰的浓度加至腹透液中，观察ＣＡＰＤ病人ＢＵＮ，Ｃｒ，总蛋白Ｄ／Ｐ值的变化及葡萄糖Ｄ／Ｄ０值及引流量的变化。结果发现：从加入丹参第二天开始ＢＵＮ，ＣｒＤ／Ｐ值增加，葡萄糖Ｄ／Ｄ０值第１天明显增加，第二天回到对照值；蛋白质从加入丹参第１天开始持续增加，而引流量并无改变     

Peritoneal protein loss in patients with high peritoneal permeability: comparison between continuous ambulatory peritoneal dialysis and daytime intermittent peritoneal dialysis

BACKGROUND: Dialysate protein loss is involved in the etiology of hypoalbuminemia and malnutrition on continuous ambulatory peritoneal dialysis (CAPD). Patients with high peritoneal membrane permeability had the lowest serum albumin (Alb) and highest dialysate protein concentrations and achieved higher small solute dialysis/plasma equilibration in a shorter time than patients with low peritoneal transport. The aim of this prospective crossover study was to evaluate whether protein loss might be decreased in patients with high peritoneal permeability on short dwell-time (DT) peritoneal dialysis. METHODS: Five high and nine high-average peritoneal transport patients were subjected to the following sequential dialysis schemes (four exchanges/day, glucose 1.5%): scheme A, three daytime exchanges (4-6 h DT) and one nightly (8-12 h DT) for 2-3 days, scheme B, 3-h DT each and dry peritoneum at night during 5 days, a wash-out period similar to scheme A, and scheme C, 2-h DT each and dry peritoneum the remainder of day and night during 5 days. Dialysate Alb, IgG, IgA, and IgM losses and adequacy of dialysis were evaluated at the end of each scheme. RESULTS: Dialysate IgM was not detected. All protein losses were reduced with the short DT dialysis schemes; however, dialysis CCl and KT/V(urea) were also decreased. In patients with high peritoneal transport type, the 3-h DT dialysis scheme achieved a reduction in Alb loss without significant reduction of adequacy of dialysis. CONCLUSIONS: Peritoneal Alb, IgG, and IgA losses are significantly reduced in patients with high peritoneal permeability on short dwell-time dialysis and extended dry periods. However, a reduction of dialysis contribution to small solute clearances was also observed, Three-hour dwell-time dialysis may be particularly useful in patients with high peritoneal transport type, as it tends to reduce peritoneal protein loss without notably reducing adequacy of dialysis.     

腹膜透析患者残余肾功能下降与营养不良的关系

目的观察残余肾功能(RRF)下降对腹膜透析(PD)患者营养状况的影响。方法选取1年内肾小球滤过率下降≥50％的32名腹膜透析患者,以肾脏尿素与肌酐清除率评估患者RRF,同时密切随访血清白蛋白、饮食蛋白摄入(DPI)和主观综合营养评估情况。结果随患者RRF下降,尿量明显减少（P＜0.01),血清白蛋白显著增加（P＜0.01),DPI增加明显。用主观综合评估(SGA)得到的营养不良发生率从开始透析时的62.5%降低到研究结束时的18.8%（P＜0.05)。结论腹膜透析患者RRF迅速下降并不一定导致DPI下降与营养状况恶化。     

持续不卧床腹膜透析患者肺动脉高压与超敏C反应蛋白的相关性分析

目的 研究持续不卧床腹膜透析(CAPE)患者中肺动脉高压的患病率,并探讨其肺动脉高压与超敏C反应蛋白水平的相关性.方法 回顾性分析在我院腹透门诊随诊的透析时间超过6个月的CAPD患者,排除有慢性阻塞性肺疾病,严重心脏瓣膜疾病、有肺栓塞病史、左室射血分数小于50%等的CAPE)患者96例,分别记录患者年龄、性别、体重、透...     

增加腹部活动对腹膜透析小分子溶质转运的影响

目的 :探讨腹部震荡和摇摆是否能增加小分子溶质转运和膜腹透析的效能。方法 :采用自身前后对照 ,观察了 18例连续不卧床腹膜透析 (CAPD)患者及 6只雄性新西兰兔腹膜透析模型 ,摇摆和腹部震荡前后透出液内溶质 (D)与血浆中相应溶质 (P)比值 (D/P)及溶质转运面积系数 (MTAC)和引流量的变化。结果 :在震动与非震动组肌酐D/P值及在 45min与 6min具有显著差异 (P <0 0 5 ) ,而两组蛋白质D/P值及引流量比较差异无显著性 (P >0 0 5 )。CAPD患者低频组与高频组 2h和 4h尿素氮D/P值及 2h肌酐D/P值较基础值均明显增加 (P <0 0 1或 0 0 5 ) ,而两组间比较差异无显著性 (P >0 0 5 ) ;蛋白质D/P值及引流量与基础蛋白质D/P值及引流量比较均无差异 (P >0 0 5 )。结论 :摇摆和腹部震荡均能增加小分子尿素氮和肌酐的转运 ,对大分子蛋白质转运及超滤量无影响 ,提示增加CAPD病人的活动能提高腹膜透析的效能。     

The Effect of Ligustrazine on Peritoneal Transport in Peritoneal dialysis

In order to investigate the effect of ligustrazine (Lig)i.p.on peritoneal permeability in peritoneal dialysis and its side effects,creatinine was given intravenously and continuously to maintain the high plasma creatinine level.All the rabbits were divided into three groups:normal control group (goup A),group B treated with 0.12% Lig and group C treated with 0.24% Lig.The peritoneal dialysis of all rabbits lasted 2h.The plasma and dialysate levels of glucose,protein and creatining were observed immediate,30min,60min,90min,120min after dialysis.Creastinine dialysate/plasma ratio (D/P),protein D/P ratio,grucose D/Do at different time points after dialysis and creatinine mass transfer area coefficient (MTAC) at 120min were calculated.The structures of peritoneum were observed under optical microscope and electron microscope after continuously intraperitoneal injection of Lig for 14 days.The results showed that the 90-min and 12-min creatinine D/P ratios in the group C were higher than in the group A.The 120-min creatinine MATC in the group C was higher than in the group A.The rabbits treated with Lig did not show significant structure changes of peritoneum and signs of peritoneal irritation.It was suggested that Lig could increase mass transfer ability of peritoneum without significant side effects.     

增加腹部活动对腹膜透析小分子溶质转运的影响

OBJECTIVE: To investigate whether the small solutes transport and the efficiency of peritoneal dialysis can be improved through ventral movement. METHODS: Eighteen continuous ambulatory peritoneal dialysis (CAPD) patients and 6 male New Zealand rabbits peritoneal dialysis models were observed. Through self and pre-post control, we compared the concentration ratio of the solutes in effluent dialyste(D) to the solutes in plasma(P), mass transfer area coefficient and the drained volume. RESULTS: The animal experiments showed that the D/P value for BUN was different prominently when comparing the vibration and non-vibration groups in 45 min and 60 min separately(P < 0.05). On the contrary, no obvious difference existed between the two groups when comparing the D/P values for protein and drained volume. The clinical study showed: D/P value for BUN at the 2 and 4 hr and D/P value for creatinine at the 2 hr increased obviously either in the low or high frequency group when compared with the control group(P < 0.01, P < 0.01, P < 0.05, respectively). D/P for protein and drained volume had no difference compared with the control group(P > 0.05). CONCLUSION: The ventral movement and vibration could efficiently increase the transport of small solutes such as BUN and creatinine while had no influence on the transport of large molecular solutes such as protein and the ultrafiltration volume. It suggested that increasing the movement of CAPD patients can improve the efficiency of peritoneal dialysis.     

腹膜透析患者盐摄入量与口腔盐敏感度相关关系的探讨

目的探讨腹膜透析患者盐摄入量与口腔盐敏感度的关系。 方法收集2008年3～12月在北京大学第三医院腹膜透析中心和山东大学齐鲁医院肾内科定期随访的45例腹膜透析患者的24?h透出液及尿液做化验检查,收取患者的饮食记录,按盐排出量和血压将这些患者分为低盐摄入组（21例）和高盐摄入组（24例）,检测每位患者口腔对氯化钠的敏感度,按味觉缺失分评价味觉缺失程度。 结果两组患者年龄、性别比例等基本生理资料差异无统计学意义（P＞0.05）,但两组患者的口腔盐敏感度差异有统计学意义（P＜0.05）,钠盐摄入多的腹膜透析患者口腔盐敏感度较钠盐摄入少者差。 结论腹膜透析患者盐摄入量与其口腔盐敏感度密切相关。     

腹膜透析患者居家环境和腹膜炎关系研究

目的探讨腹膜透析(PD)患者居家环境和PD相关性腹膜炎的关系,并分析引起环境不达标的危险因素。方法对义乌市辖区内86例PD患者进行家访,按既往PD相关性腹膜炎发生史将患者分为初发腹膜炎组（19例）与未发腹膜炎组（67例）;自设调查表,对居家环境进行现场评分,按得分情况将患者分为居家环境合格组（47例）和居家环境不合格组（39例）;按医院Ⅲ类环境标准对换液间环境（空气和桌面）进行细菌采样培养。结果与未发腹膜炎组相比,初发腹膜炎组患者透析龄较长,个人年经济收入较低,本人操作比例较高（均P＜0.05）;透析龄长、个人年经济收入低是腹膜炎发生的独立危险因素。居家环境合格组、居家环境不合格组患者个人年经济收入、工作状况、腹膜炎发生率等方面比较差异有统计学意义（均P＜0.05）;个人年经济收入低是患者居家环境不合格的独立危险因素。换液间采样培养结果以溶血性葡萄球菌、表皮葡萄球菌等凝固酶阴性葡萄球菌为主,空气灰尘大、紫外线灯强度不合格是换液间环境不达标的独立危险因素。结论对居家环境不合格、经济条件欠佳的PD患者,应加强透析间环境的维护,有针对性地进行家访,有助于降低腹膜炎发生风险。