腹膜转运特性对持续性不卧床腹膜透析患者营养状况的影响

目的 了解持续性不卧床腹膜透析(CAPD)患者腹膜转运特性对营养状况的影响.方法 对73例CAPD患者进行横断面研究,根据腹膜平衡试验(PET)结果分为高转运组43例与低转运组30例,根据主观综合性营养评估法(SGA)评分对患者营养状况进行评估,同时对两组白蛋白(ALB)、总蛋白(TP)、血红蛋白(Hb)、原发病、年龄、体重、透析时间、超滤量、血尿素氮(BUN)、血肌酐(SCr)等进行比较.结果 两组患者年龄、体重、超滤量、收缩压、舒张压、Hb、SGA评分、BUN、SCr 比较差异无统计学意义(P＞0.05);高转运组透析时间(14.35±13.88)个月,原发病为糖尿病肾病(DN) 16例、非DN 27例,TP(64.98±7.59)g/L,ALB(34.61±5.43) g/L,与低转运组的(24.20±19.62)个月、12例和18例、(68.73±6.96) g/L、(38.71±3.82) g/L比较差异有统计学意义(P＜0.05).结论 不同腹膜转运特性CAPD患者营养状况存在明显差异,CAPD高转运患者营养状况较差.     

Effect of hemodialysis and peritoneal dialysis on redox status in chronic renal failure patients: a comparative study

Objective  

To investigate the effects of hemodialysis (HD) and periotoneal dialysis (PD) on oxidative stress in chronic renal failure patients (CRF).     

腹膜转运和营养状况在腹膜透析充分性评价中的作用

目的探讨腹膜转运特性对尿毒症腹膜透析患者营养状态的影响,评价二者在腹膜透析充分性评价中的地位。方法采用快速腹膜平衡试验判断腹膜转运功能[腹膜透析液肌酐与血肌酐的比值（D／Per）],将53例腹膜透析患者分为高转运（D／Per≥0．65）和低转运（D／Per〈0．65）两组。计算尿素清除指数（Kt／v）和总肌酐清除率（TCer）。采用实验室检查（血清白蛋白、前白蛋白和转铁蛋白,血红蛋白,瘦体重和瘦体重百分比）以及主观综合性评定法（SGA）评估患者的营养状况。结果低转运组包括患者30例,高转运组包括23例。高转运组患者的年龄、D／Per（0．82±0．15vs．0．55±0．08,P〈0．01）和TCer（62．93％±25．98％佛．49．69％±16．92％,P〈0．05）均显著高于低转运组,血清白蛋白和转铁蛋白,血红蛋白水平,瘦体重百分比和SGA评分均显著低于低转运组（P〈0．05）,血清白蛋白与Kt／v呈显著负相关（r=-0．2708,P〈0．05）。结论腹膜高转运者溶质清除率高但营养状态较低转运者差。营养状况是判定透析是否充分的条件之一。应加强高转运及高龄患者的饮食管理和指导。     

综合性营养评估法在维持性血液透析患者中的应用

目的 对血液透析患者的几项营养指标进行评估.方法 对142例维持性血液透析(MHD)患者进行主观综合性营养评估(SGA)、膳食调查、生化参数的测定.结果 依据SGA评分,在营养良好、轻中度营养不良及重度营养不良三组间进行以下指标比较:平均每日每公斤体重能量(DEI)和蛋白质摄入(DPI)、血白蛋白(ALb),均有显著性差异(P＜0.001～0.05).但营养良好组的DEI和DPI异常率高达46.0%、49.0%,重度营养不良组中各指标异常率均在80%以上.血前白蛋白(PA)与血ALb有显著相关(P＜0.01),与DPI、DEI均无相关.结论 SGA是评价MHD患者营养状况的简便方法,但还需其它反映营养状况不同侧面指标的补充,如DEI、DPI、血ALb、血PA.     

综合性营养评估法在维持性血液透析患者中的应用

目的对血液透析患者的几项营养指标进行评估。方法对142例维持性血液透析（MHD）患者进行主观综合性营养评估（SGA）、膳食调查、生化参数的测定。结果依据SGA评分,在营养良好、轻中度营养不良及重度营养不良三组间进行以下指标比较：平均每日每公斤体重能量（DEI）和蛋白质摄入（DPI）、血白蛋白（ALb）,均有显著性差异（P〈0.001～0.05）。但营养良好组的DEI和DPI异常率高达46.0%、49.0%,重度营养不良组中各指标异常率均在80%以上。血前白蛋白（PA）与血ALb有显著相关（P〈0.01）,与DPI、DEI均无相关。结论SGA是评价MHD患者营养状况的简便方法,但还需其它反映营养状况不同侧面指标的补充,如DEI、DPI、血ALb、血PA。     

锌与持续非卧床腹膜透析患者营养和免疫状态的关系

目的 研究锌与持续非卧床腹膜透析（CAPD）患者营养和免疫状态的关系.方法 以45例病情稳定的CAPD患者为研究对象,测定膳食锌摄入量和血清锌水平,并与年龄和性别相匹配的45名健康人进行对比.分析CAPD患者膳食锌摄入量和血清锌水平与主观整体营养评价（SGA）分数、血细胞计数、白蛋白（Alb）、前白蛋白（PA）、C-反应蛋白（CRP）及淋巴细胞亚群等营养和免疫指标的相关性.结果 CAPD组患者膳食锌摄入不足率（P=0.007）和低血锌率（P=0.036）均明显高于健康对照组,CD8水平明显低于健康对照组（P=0.000）,CD4/CD8水平明显高于健康对照组（P=0.033）.相关性分析检测结果显示,CAPD患者膳食锌摄入量与血清前白蛋白水平呈显著正相关（r=0.577,P=0.000）,与SGA评分（r=-0.354,P=0.015）和CRP（r=-0.354,P=0.015）呈显著负相关,与各类淋巴细胞亚群和CD4/CD8无明显相关性;血清锌水平与血红蛋白（r=0.411,P=0.005）、红细胞比容（r=0.345,P=0.023）、白细胞（r=0.318,P=0.035）、SGA评分（r=0.417,P=0.005）及CRP（r=0.342,P=0.027）均呈显著正相关,与各淋巴细胞亚群和CD4/CD8均无明显相关性.结论 CAPD患者存在锌缺乏.充足的膳食锌有助于促进蛋白质合成,提高整体营养水平.较高的血清锌水平有利于血红蛋白的合成,改善贫血.     

血液透析和腹膜透析患者生活质量调查

目的：了解血液透析和腹膜透析病人的生活质量及与生活质量有关的因素。方法：采用健康生活量表36项（SF-36）问卷调查31例腹膜透析病人和46例血液透析病人。结果：两组病人的一般资料和生活质量无显著差异。多元逐步回归分析发现,教育程度和治疗依从程度进入回归模型。结论：血液和腹膜透析这两种方式在体力、精神方面均无显著差异,受教育程度高和治疗依从性好可显著提高患者生活质量。     

Energy supplementation and the nutritional status of hemodialysis patients

Twenty-one patients undergoing regular hemodialysis completed a trial of energy supplementation. Nine patients added the glucose polymer Polycose to their usual diet and 12 acted as control subjects. The supplemented patients were asked to incorporate 100 or 150 g polymer, equivalent to 1600 or 2400 kJ (400 or 600 kcal) into their usual diet, daily for 6 mo. This resulted in a mean increase in energy intake of 1630 kJ (p less than 0.05) and a mean weight gain of 3.1 kg (p less than 0.005). The addition of glucose polymer to the diet resulted in a mean increase in body fat of 1.8 kg and the lean body mass increased by 1.3 kg. No significant effect on plasma triglycerides, urea, or creatinine was detected. The intake of macro- and micronutrients was not adversely affected and no clinical or psychological side effects were reported. Follow-up of these patients showed that the weight gain was maintained after 6 mo. Glucose polymer was an effective energy supplement that had beneficial effects on the nutritional status of hemodialysis patients.     

腹膜透析与血液透析患者发生菌血症危险因素分析

目的分析腹膜透析(PD)及血液透析(HD)患者的菌血症发生率以及危险因素,探索更好的预防措施,改善患者的生活质量。方法回顾性分析医院2006年1月-2010年12月维持性透析的224例患者的临床资料,对其菌血症进行统计。结果 224例患者发生菌血症78例,发生率为34.82%;血管通路感染是血液透析患者菌血症主要原因占54.69%,腹膜炎是腹膜透析患者感染菌血症的主要感染部位占57.14%,两者间对比差异有统计学意义(P<0.01);血液透析患者中金黄色葡萄球菌是最常见的病原菌占39.06%,而凝固酶阴性葡萄球菌在腹膜透析患者中最常见占35.71%;腹膜透析患者每年总体菌血症发生率为5.36%,血液透析患者为7.62%;腹膜透析患者感染以凝固酶阴性葡萄球菌最常见占21.27%,血液透析患者感染以金黄色葡萄球菌为主占27.53%;血液透析患者菌血症常见感染部位为血管通路;腹膜炎是腹膜透析患者菌血症的常见感染;年老、透析初期、血液透析相对腹膜透析、使用中心静脉透析导管、糖尿病、低白蛋白血症为菌血症的危险因素。结论开始透析之前建立永久通路(内瘘或腹膜透析置管)、良好的营养状况能减少透析患者感染菌血症的发生。     

Electrolytes and fluid management in hemodialysis and peritoneal dialysis.

The kidney is a complex and vital organ, regulating the electrolyte and fluid status of the human body. As hemodialysis (HD) and peritoneal dialysis (PD) are forms of renal replacement therapy and not an actual kidney, they do not possess the same physiologic regulation of both fluid and electrolytes. Precise regulation of fluid and electrolytes in the HD and PD population remains a constant challenge. In this review, fluid status of both HD and PD will be examined, as well as sodium, potassium, phosphorous, and calcium. Each electrolyte will be analyzed by its physiological significance, the complications that arise when a proper balance cannot be maintained, and methods to correct these imbalances. An overview of the fluid compartments and volume of distribution within the body will be discussed. Ultrafiltration, a modality used in both forms of renal replacement therapy, will be defined, along with its impact on fluid status. Fluid assessment will be addressed, along with proper maintenance of fluid homeostasis. By having an understanding of the pathophysiology behind the fluid and electrolyte abnormalities that occur in end-stage renal disease, one can direct proper management with medications, diet, and alterations in dialysis to provide patients with the most optimal form of renal replacement therapy available.     

终末期肾病血液透析和腹膜透析治疗经济学评价研究综述

为了给我国终末期肾病透析治疗经济学评价研究的发展提供可借鉴的经验,对国内外前期开展的血液透析和腹膜透析治疗的经济评价进行综合评述。通过比较发现,我国现有的评价研究在研究设计和方法选择方面存在不足,建议参考国外最新研究进展,进行严谨的评价项目设计,并选取适宜的分析方法。     

肾病透析患者营养状况评价

目的：评价肾病透析患的营养状况,以制订营养治疗方案。方法：用体检和生化分析对106例肾病透析患营养状况进行评价,。结果：83例血透和23例腹透患,分别有54．2％和47．8％,营养不足,与三头肌皮褶厚度和BMI的结果均一致。血清三酰甘油酯显增高,Apo-a含量升高,血清视黄醇结合蛋白偏高,血清支链氨基酸和必需氨基酸均降低,血磷高于正常。血透组血红蛋白、淋巴细胞明显降低,腹透组总蛋白、白蛋白、淋巴细胞均显降低,结论：肾病透析患营养不足较为严重,并有高脂血症、低蛋白血症和高磷血症。     

血液透析与腹膜透析的卫生经济学研究概述

目的 比较血液透析与腹膜透析人群的费用、效果及其影响因素，分析其疾病经济负担，剖析现行医疗保险补偿模式对透析技术的影响，进而为临床合理应用透析技术及透析相关政策的调整和完善提供参考依据。方法 采用回顾性调查方法，对首次透析时间在1995-1998年间的上海市6所医院155例血液透析患者和223例腹膜透析患者的费用和效果进行比较。用多元回归法分析费用的影响因素，用COX回归方法分析死亡风险的影响因素，用Logistic回归法分析生命质量的影响因素。回顾性调查210例存活者的疾病负担。运用政策分析法分析补偿模式对透析技术应用的影响。结果 血液透析与腹膜透析人群的死亡风险、生命质量以及医疗费用并无显著差异，而统计描述差异是由于两类人群透析初始的健康状况不均衡造成的。透析人群疾病伤残程度很高，疾病经济负担沉重，负债透析的现象普遍。结论 医疗保险对腹膜透析与血液透析的费用补偿方式差异，造成血液透析技术的过度利用，进一步加重了各方费用的负担。因此，有必要从筹资、补偿模式、供方医疗行为规范等方面调整和完善透析相关政策。     

Energy expenditure and nutritional status of coal miners: A cross-sectional study

The objectives of this study were to assess the nutritional status, daily energy intake, and daily energy expenditure of coal miners in Turkey. A total of 135 healthy coal miners (aged 19–64 years) were evaluated. Heart rates were measured using Polar watches, and the total energy expenditure was calculated using physical activity level formula and Hiilloskorpi equation. The average body mass index of the participants was 25.7 ± 3.98 kg/m², and the average energy intake was 3,973.7 ± 420.85 kcal. According to Dietary Reference Intakes, the energy and nutrient intakes of the miners were adequate, except for the intake of vitamin D. The coal miners were found to be at moderate (43.0%), heavy (41.5%), and very heavy (13.3%) activity levels. Calculations of the energy expenditure at work were found to be 2,189.8 ± 376.19 to 2,788.8 ± 359.89 kcal per day. Further studies have to be conducted for developing national standards for each occupation.     

血液透析和腹膜透析的成本分析

目的：比较血液透析和腹膜透析的成本构成，为制定、完善医保政策提供依据。方法：对上海市4家医院1999年度血液透析和腹膜透析的成本构成及利润情况进行分析。结果：血液透析均次成本中材料成本占35％－37％，设备成本占38％－44％，其获利的增幅受人（次）数和均次利润的共同影响。腹膜透析均次成本中材料成本超过97％，其获利仅与所服务的人（次）数有关。结论：两种透析方法存在着较大的利润差异，导致血液透析不适宜地扩张，抑制了腹膜透析技术的合理应用。     

维持性血液透析病人的营养状况评价

目的:应用主观全面评定法(SGA)对维持性血液透析(MHD)病人的营养状况进行评价.方法:采用SGA结合有关生化指标,人体测量指标和饮食评估,对127例MHD病人的营养状况进行综合评价.结果:127例病人中营养良好者75例,轻中度营养不良39例,重度营养不良13例,总营养不良发生率为40.9%.各营养状况组之间血清ALB、PA、肌酐、肱三头肌皮皱厚度、饮食蛋白摄入量和蛋白质分解率差异显著,而三组间Kt/V无显著差异.结论:血液透析病人营养不良的发生率较高,与蛋白质摄入不足、炎症、血液透析过程本身等因素有关.     

A comparison of responsiveness to hepatitis B vaccination in patients on hemodialysis and peritoneal dialysis

The doses of hepatitis B vaccine given to peritoneal dialysis (PD) patients are currently based on responsiveness data from hemodialysis (HD) patients. To determine whether the doses are also appropriate from PD patients, we did a head-to-head comparison of short-term and 2-year responses to hepatitis B vaccination of HD patients and PD patients. We evaluated serum titers of the antibody to hepatitis B surface antigen (anti-HBs) after the patients had completed a course of four consecutive intramuscular vaccinations (40 microg of Engerix-B administered into the deltoid muscle at 0, 1, 2, and 6 months) in 69 dialysis patients (47 HD and 22 PD patients) who were both hepatitis B surface antigen (HBsAg) and anti-HBs negative. No patients had received a hepatitis B vaccination prior to the study. There was no significant difference in response to hepatitis B vaccination between the HD and PD groups (78.7% versus 77.3%, p=0.33). The seroconversion rate defined as anti-HBs > or = 10IU/L was influenced only by age (p=0.011). There was also no significant difference in responsiveness between the HD and PD groups (60% versus 50%, p=0.41) at a 2-year follow-up. We conclude that doses of HBV vaccine being used for HD patients are also appropriate for PD patients and a booster dose of vaccine is required to maintain seroprotection for those who lost protecting anti-HBs.     

杭州市腹膜透析和血液透析治疗费用与疗效的比较研究

为比较腹膜透析和血液透析的费用和效果,对浙江大学附属第一医院和杭州市中医院的腹膜透析和血液透析者进行问卷调查。结果显示：（1）腹透者花费的年透析费用和因透析发生的年总医疗费用低于血透者;（2）腹透者可以间隔较长的时间到医院就诊,对于患者的治疗比较方便;（3）腹膜透析对生命质量的改善优于或至少不低于血液透析;（4）腹透并发症住院率高于血透。故建议积极推广腹膜透析,同时提高腹膜透析服务质量,降低其并发症发生率。