Peritonitis during continuous ambulatory peritoneal dialysis in children.

The use of continuous ambulatory peritoneal dialysis (CAPD) in children has proved beneficial. However, peritonitis remains the major complication. A review of the incidence of peritonitis in 55 children (mean age 9.6 years) who underwent CAPD between 1978 and 1984 showed that there were 67 episodes of peritonitis (1 per 9.4 patient-months) in 33 of the 55. Three patients accounted for 22 of the episodes. In all cases, treatment with antibiotics, given intraperitoneally, was successful. Cephalothin was routinely given for infections due to gram-positive organisms, tobramycin for infections due to gram-negative organisms. Peritonitis recurred in seven patients, of whom five had to have their catheters replaced because of associated chronic infections of the deep peritoneal cuff, the exit site or the catheter tunnel. Although peritonitis was a common complication of CAPD in this population, it did not affect the success of the technique.     

Amyloidosis in continuous ambulatory peritoneal dialysis

We report a 53 year old man with chronic renal failure on continuous ambulatory peritoneal dialysis. Following eight episodes of severe peritonitis over a 2 year period, he died and was found to have widespread AA amyloid at post-mortem.     

持续性非卧床腹膜透析患者退出原因分析

目的探讨持续性非卧床腹膜透析（CAPD）患者的退出原因及相应的防治措施。方法收集2005年1月~2010年1月因慢性肾衰竭接受CAPD的140例患者临床资料,分析患者退出腹膜透析的时间和原因,并对死亡病例的死因进行分析。结果 140例患者中因各种原因退出腹膜透析共37例,退出率为26.4%（37/140）;其中死亡21例,转血液透析7例,肾移植9例。结论死亡是CAPD患者短期内退出腹膜透析的主要原因,而心脑血管事件、腹膜炎是导致CAPD患者死亡的主要原因。因此应积极加强透析前的系统治疗及腹膜透析患者透析后的持续合理管理。     

不同透析方式对尿毒症性皮肤瘙痒症的影响

目的：对尿毒症维持性血液透析和腹膜透析的患者进行调查,比较不同的透析方式对尿毒症性皮肤瘙痒症的影响。方法：选取91例稳定期维持性透析治疗的尿毒症患者作为研究对象,其中血液透析治疗组（A组）患者50例,腹膜透析治疗组（B组）患者41例。血液透析组按患者治疗模式中有无血液灌流或血液滤过治疗再分为普通血液透析治疗组（27例）和组合型血液透析治疗组（23例）。采用麦吉尔疼痛问卷调查表对每位透析患者进行评分,并记录患者的一般情况及同期的生化指标。结果：血液透析组患者瘙痒发生率及瘙痒程度显著低于腹膜透析组（P〈0.05）。组合型血液透析治疗组瘙痒发生率、瘙痒程度显著低于腹膜透析组（P〈0.01）,而普通血液透析组和腹膜透析组患者比较在瘙痒发生率和瘙痒程度上差异无统计学意义（P〉0.05）。相关性分析结果显示,在全体透析患者中瘙痒的发生与透析方式及尿量、甲状旁腺素（PTH）和β2微球存在明显相关;在血液透析组患者瘙痒发生情况与透析方式、β2微球相关,腹膜透析组患者瘙痒发生情况与PTH相关。结论：组合型血液透析治疗模式的运用可以显著降低尿毒症维持性透析患者的瘙痒发生以及瘙痒程度。     

138例持续非卧床腹膜透析患者再住院原因分析

目的分析在家中进行CAPD患者住院的主要原因。方法分析138例持续性非卧床腹膜透析患者住院时间和住院原因,同时测定透析充分性、营养状况和心血管系统状况等指标。结果住院的首位和次位原因分别是心脑血管系统疾病和腹膜透析相关性感染,其中容量负荷过重导致心功能衰竭是患者住院的重要原因之一。结论心脑血管系统疾病和感染性疾病是导致腹膜透析患者住院的重要因素。营养、炎症和心血管状态对腹膜透析患者的预后具有重要的影响作用。腹膜炎和透析不充分仍然是导致腹膜透析患者住院的原因之一。     

艾考糊精腹膜透析液改善持续非卧床腹膜透析患者的新生血管化

目的 通过检测腹膜透析(简称腹透)流出液血管内皮生长因子(VEGF)和临床超滤量和溶质清除对比,观察艾考糊精腹透液对维持性腹透患者腹腔新生血管化的影响.方法 选择2006年1至12月在我院肾内科透析的54例持续非卧床腹透(CAPD)患者行随机双盲前瞻性研究.入选的CAPD患者根据夜间使用的腹透液被随机分为7.5%艾考糊精腹透液组(ICO组,27例)和2.5%葡萄糖腹透液组(GLU组,27例).为期4周.基线期测定4 h腹透液和血液中肌酐的比值(D/PCr)反映腹膜功能.基线和4周时分别检测夜间腹透流出液超滤量、肌酐清除率(CCr)、VEGF和IL-6水平.为消除超滤和留腹时间可能造成的误差,用腹透流出液VEGF呈现率反映腹腔中新生血管化情况.结果 54例患者入选研究.基线期各组之间差异均无统计学意义.随访2和4周后ICO组超滤量和腹膜CCr均明显高于GLU组.夜间腹透流出液VEGF水平与留腹4 h的D/PCr呈正相关(r=0.68,P＜0.01),与留腹4 h的超滤量呈负相关(r=-0.51,P＜0.01).2组患者基线期VEGF呈现率差异无统计学意义,随访4周后,VEGF呈现率在GLU组有上升趋势,在ICO组有下降趋势,但差异均无统计学意义,而△VEGF呈现率(4周VEGF呈现率-基线期VEGF呈现率)在2组之间差异有统计学意义(9.5±20.2 vs-13.4±26.1,P＜0.01).血IL-6和腹透流出液IL-6水平以及腹透流出液细胞数在2组之间差异无统计学意义.结论 与2.5%葡萄糖腹透液相比,艾考糊精腹透液能显著降低腹透流出液中的VEGF水平从而对改善腹腔局部的新生血管化具有益作用.     

灯盏花素对腹膜透析患者腹膜转运效能的影响

目的 观察灯盏花素对于腹膜透析患者腹膜转运效能的影响。方法 采用自身对照方法,选取20例终末期尿毒症持续不卧床腹膜透析治疗患者,且腹膜透析效能处于低平均转运以下。在静脉输注灯盏花素15～30d,对比用药前后PET的变化。结果 用药后腹膜肌酐D/P值较用药前升高（0.465±0.049）vs（0.545±0.048）（P<0.01）,葡萄糖D/D0值2、4小时均有所下降（0.799±0.161）vs（0.660±0.053）, （0.609±0.099）vs（0.479±0.049）（P<0.01）,腹膜透析超滤量无明显差异。结论 灯盏花素能够提高持续不卧床腹膜透析患者对于肌酐的清除,减少葡萄糖的重吸收,从而改善腹膜转运效能。     

持续非卧床腹膜透析患者营养状况评价

【摘要】目的探讨持续非卧床腹膜透析（continuous ambulatory peritoneal dialysis, CAPD）患者的营养状况。方法随机选择病情稳定,符合观察奈件的透析患者52例（男／女,32／20）。进行膳食营养评价、半定量SGA评分、人体测量以及生化指标检测。结果CAPD患者营养不良发生率高：以SGA评分作为评价指标,78．8％的患者有不同程度的营养不良：vJ,ALB作为评价指标,67．3％的患者营养不良;基于AMC判断,则有55．8％的患者营养不良。营养摄入量与营养评价指标关系密切：DEI与BMI呈正相关（P〈0．05）,与ALB、PA呈正相关（P〈0．05,P〈0．01）,而与SGA、CRP呈负相关（P〈0．01,P〈0．05）：DPI与PA呈正相关（P〈0．01）。蛋白质摄入充分组PA明显高于摄／k不足组（P〈0．01）;热量摄入充分组ALB高于摄入不足组（P〈0．05）。结论CAPD患者营养不良发生率高,膳食营养与CAPD患者营养状况密切相关．就维持血浆蛋白而言,摄入充足的热量可能比蛋白质更重要。     

Laparoscopic cholecystectomy in a patient on continuous ambulatory peritoneal dialysis

The patient was a 72-year-old man who was receiving continuous ambulatory peritoneal dialysis (CAPD) with a diagnosis of chronic renal failure. Although his response to dialysis therapy was favorable, right hypochondralgia and fever occurred, and gallstones were detected by abdominal ultrasonography and computed tomography. Drip-infusion cholangiography (DIC) revealed neither dilation nor calculus in the common bile duct. The patient was diagnosed as having acute cholecystitis and cholecystolithiasis and, in consideration of his general condition, laparoscopic cholecystectomy was carried out. Pneumoperitoneum was performed through a CAPD tube, and a 10 mm-trocar was carefully introduced through a supraumbilical incision so as not to injure the CAPD tube. Since intraoperative cholangiography showed a condition similar to preoperative DIC, only cholecystectomy was undertaken. The postoperative course was uneventful, with neither postoperative hemorrhage nor leakage of dialysate from the wound.     

Intraperitoneal insulin in uraemic diabetics undergoing continuous ambulatory peritoneal dialysis

The kinetics of absorption of intraperitoneally administered insulin were studied in nine uraemic insulin-dependent diabetics undergoing continuous ambulatory peritoneal dialysis (CAPD). In each of three studies 20 U of regular insulin was directly injected as a bolus into the peritoneal cavity through an indwelling Tenckhoff catheter. In two procedures the insulin injection was followed by the instillation of either 2 litres of 1.5% dextrose dialysates or 2 litres of 4.5% dextrose dialysate. In the third 20 ml of saline was used to flush the tubing. Plasma free insulin values rose more rapidly and reached significantly higher concentrations (55.6 +/- 18.8 mU/l) when the insulin had been injected into an empty peritoneal cavity than when it was followed by dialysate. These differences were observed despite the fact that most of the insulin injected was retained by the patients. Since the plasma insulin values did not differ after instillations of dialysate containing 1.5% and 4.5% dextrose, the osmolality of the dialysate seemed not to affect insulin absorption, and the dilution of the insulin probably delayed its transfer through the peritoneum. These findings suggest that insulin given intraperitoneally to patients undergoing CAPD will be most effective if it is given into an empty peritoneal cavity at least 30 minutes before the dialysate is instilled.     

持续不卧床腹膜透析患者的营养评估分析

目的调查持续不卧床腹膜透析(CAPD)患者的营养状况并分析其相关影响因素。方法①调查了78例CAPD治疗患者的一般情况及原发病因;②采用MDRD方程计算肌酐清除率,以评估患者的残余肾功能;③以主观综合性营养评估(SGA)、握力试验等指标评估病人营养状况;④用Charlson指数评估患者合并症情况;⑤采用ECOG和Karnofsky活动指数评分评估患者的活动能力。结果①依据SGA评分,CAPD患者营养不良总发生率为51.3%;与营养良好组相比,营养不良组患者的Hb、A lb、右侧肱三头肌皮褶厚度、髂皮褶厚度降低,CRP明显升高(P(0.05);与营养良好组相比,虽然营养不良组患者的CCr、透析液总剂量、液体总清除量没有明显的差异,但透析液糖浓度、透析龄、腹腔液体的超滤量明显高于营养良好组,而尿量明显减少(P(0.05);④与营养良好组相比,营养不良组患者的Charlson合并症指数、水肿发生率明显增高,活动能力明显减低,(P(0.05)。结论CAPD患者营养不良的发生率高,残肾功能、炎症反应、贫血、合并症情况、容量负荷状态等诸多因素均可影响CAPD患者的营养状态。     

140例持续性非卧床腹膜透析患者住院原因分析

目的调查持续性非卧床腹膜透析患者住院的原因。方法对140例持续性非卧床腹膜透析患者住院时间和住院原因,同时测定透析充分性、营养状况和心血管系统状况等指标。结果住院的首位和次位原因分别是心脑血管系统疾病和腹膜透析相关性感染,其中容量负荷过重导致心功能衰竭是患者住院的重要原因之一。结论心脑血管系统疾病和感染性疾病是导致腹膜透析患者住院的重要因素。营养、炎症和心血管状态对腹膜透析患者的预后具有重要的影响作用。腹膜炎和透析不充分仍然是导致腹膜透析患者住院的原因之一。     

Effect of continuous ambulatory peritoneal dialysis on a British renal unit

Experience in the use of continuous ambulatory peritoneal dialysis (CAPD) for the treatment of end stage renal failure in Nottingham was reviewed. During six years 150 patients aged from 11 to 73 received this type of treatment. At three years patient actuarial survival was 69% and CAPD technique survival was 41%. Although CAPD was satisfactory as a first treatment for many patients, its long term use was possible in only a few. Actuarial survival of patients who changed to haemodialysis was 64% at one year after the change, suggesting that unsuccessful CAPD increased the risk of death. Hospital haemodialysis was the only suitable form of treatment for most patients in whom CAPD had been abandoned. British renal units have adopted CAPD to a much greater extent than those in Europe, but care in the selection of patients is necessary to reduce mortality, and many patients may eventually need hospital haemodialysis. Greater numbers of hospital haemodialysis places will probably have to be made available to meet this extra demand.     

持续非卧床腹膜透析患者结局预测因素分析

目的 了解持续非卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)患者累积生存率,分析CAPD患者结局的预测因素.方法 采用前瞻性观察研究方法,连续纳入符合观察条件的CAPD患者148例,调查生活方式并检测腹膜透析前基线肾功能和血清生化指标,采用Kaplan-M...