腹膜透析患者的依从性与腹膜透析并发症的关系调查研究

目的：了解腹膜透析患者对腹膜透析相关培训的依从性,探讨患者依从性与腹膜透析相关并发症的关系,为降低腹膜透析的并发症,改善腹膜透析患者的预后性提供参考依据。方法采用自行设计的调查表对60例透析超过半年的腹膜透析患者进行调查,分析患者依从性与腹膜透析相关并发症的关系。结果通过系统的腹膜透析透析前培训,患者能配备透析相关设备,但操作过程存在不规范行为,尤其以年纪大、合并基础疾病患者明显。腹膜透析相关并发症与患者依从性存在负相关关系。结论腹膜透析患者依从性与其并发症的发生有关,提高患者对透析培训的依从性,有助改善患者透析预后。     

腹膜透析进展

1　概述腹膜透析是利用腹膜作为透析膜向腹腔内注入透析液 ,利用溶质浓度梯度和渗透清除体内潴留的代谢废物和过多的水分的一种方法 ,以达到清除毒素、脱去多余水分、纠正酸中毒和电解质紊乱的治疗目的。腹膜透析用于临床始于 192 3年 ,德国 Ganter首次将此技术应用于一名因子宫癌所致梗阻性肾病的尿毒症患者 ,使患者症状一度改善 ,并预言随着技术改进 ,腹膜透析将成为有效治疗尿毒症的方法。1976年 ,Popovich提出持续性不卧床腹膜透析 (Conti-nous am bulatory peritoneat dialysis,CAPD) ,随着透析相关技术的改进和透析方案不断完善以…     

腹膜透析技术的发展现状

由于本身的特点尤其是技术上的不断进步,腹膜透析技术在肾功能衰竭的治疗中得到更加广泛的应用。本文介绍了近年来腹膜透析的研究重点及其发展方向。     

腹膜透析患者并发腹膜炎的原因分析与护理

目的探讨降低腹膜透析患者并发腹膜炎的状况及其主要原因。方法针对65例腹膜透析患者中发生腹膜炎的机率及其原因进行分析。结果65例患者中共有14例发生了腹膜炎,占21.5%;其中6例为操作不规范所致,占50%;出口处感染2例,占14%;换人操作未经系统培训2例,占14%;重复使用碘伏帽1例,占7%;使用混浊、污染腹膜透析液2例,占14%;短管脱落处理不当1例,占7%。结论外源性感染是发生腹膜透析相关性腹膜炎的主要原因,针对原因进行预防可减少腹膜炎的发生率。     

腹膜透析患者抗生素脑病危险因素分析

目的:分析腹膜透析患者使用抗生素出现抗生素脑病的危险因素。方法:回顾性分析本院2004-01—2018-01收治的64例维持性腹膜透析(CAPD)患者的临床资料,其中发生抗生素脑病患者10例,作为观察组,其余54例未发生抗生素脑病,从中随机选取15例作为对照组。比较两组间性别、年龄、平均CAPD时间、血液透析转为腹膜透析例数、血压(BP)、矫正钙、血磷、血浆白蛋白、标准蛋白分解率(nPCR)、血红蛋白(Hb)、血肌酐(Scr)、残存肾功能(GFR)、腹膜清除率、每周腹膜总肌酐清除率、每周腹膜总尿素清除指数、应用β-内酰胺类抗生素例数、抗生素使用时间等的分布差异,将差异有统计学意义的指标,经二分类Logistic回归分析引起抗生素脑病的可能因素。结果:抗生素脑病发生率为15.63%(10/64)。上述18个指标中年龄、平均CAPD时间、由血透转为腹透例数、收缩压、舒张压、GFR、每周总肌酐清除率、每周总尿素清除指数、应用β-内酰胺类抗生素例数、应用β抗生素时间3天等10个指标具有组间差异(P0.05或P0.01);将此10个指标纳入Logistic回归模型,分析发现除血压、每周腹膜总肌酐清除率和每周腹膜总尿素清除指数外其余各项指标均为腹膜透析患者发生抗生素脑病的独立危险因素(P0.05或P0.01)。结论:腹膜透析患者抗生素脑病发生率较高,影响因素较多,临床应重视管理,防范风险。     

正常体重指数孕妇孕期体重增长与妊娠结局的关系

目的总结2009年1月至2010年1月我院产检的正常体重指数孕妇妊娠期体重增长的情况,并对其妊娠结局按不同体重增长情况进行分析,得出体重增长与妊娠结局的关系。方法对2009年1月至2010年1月在我院检查及分娩单胎的1382名正常体重指数的孕妇进行分析,按2009年Institute of Medicine(IOM)体重增长指南将孕妇进行分组,分为过少增长、正常增长及过多增长组,并随访妊娠结局。结果 1382名正常体重指数的孕妇体重过少增长、正常增长及过多增长的比率分别为11.43%、37.63%、50.94%。体重增长情况与孕妇受教育程度及社会职务存在相关性,三组妊娠结局进行比较,剖宫产率、妊娠期高血压(PIH)、巨大儿、低体重儿的发生率存在显著性差异,而妊娠期糖尿病(GDM)、产后出血的发生率无显著性差异。结论尽管孕前体重指数正常,仍有超过一半的孕妇体重增长超过标准,且过多或过少的体重增长均会导致不良的妊娠结局,故妊娠期提供正确的体重增长指导对正常孕妇仍很重要。     

体重指数和血清甘油三酯水平对急性胰腺炎预后的影响研究

目的研究体重指数和血清甘油三酯水平对急性胰腺炎预后的影响,为临床防治急性胰腺炎提供一定的理论依据。方法临床入选183例急性胰腺炎患者,根据病情严重程度分为轻型组（92例）与重型组（91例）,统计分析两组患者的相关临床资料。结果在体重正常患者中MAP的发生率为47.83%,而SAP发生率为27.47%,两者具有统计学差异（P〈0.05）;在体重超重者患者中MAP和SAP发生率分别为39.13%、43.00%,两组间没有统计学差异（P〉0.05）;在肥胖患者中SAP发生率（28.57%）明显高于MAP发生率（13.04%）（P〈0.05）。与TG水平正常组相比较,高脂血症组的血钙和PaO2水平明显降低（P〈0.05）,同时高脂血症组的血清肌酐和血糖水平也是显著升高的（P〈0.05）。同时,两组患者在血清甘油三酯水平和体重指数方面均具有统计学差异（P〈0.05）。结论血清甘油三酯水平和体重指数可能是预测急性胰腺炎病情严重程度的两个危险因素。     

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.     

Improving Survival Rate of Korean Patients Initiating Dialysis

Purpose

The aim of this study was to investigate whether the survival rate among Korean dialysis patients changed during the period between 2005 and 2008 in Korea.

Materials and Methods

A total of 32357 patients who began dialysis between January 1, 2005 and December 31, 2008 were eligible for analysis. Baseline demographics, comorbidities, and mortality data were obtained from the database of the Health Insurance Review & Assessment Service.

Results

Kaplan-Meier curves according to the year of dialysis initiation showed that the survival rate was significantly different (log-rank test, p=0.005), most notably among peritoneal dialysis (PD) patients (p<0.001), although not among hemodialysis (HD) patients (p=0.497). In multivariate analysis, however, patients initiating either HD or PD in 2008 also had a significantly lower risk of mortality compared to those who began dialysis in 2005. Subgroup survival analysis among patients initiating dialysis in 2008 revealed that the survival rate of PD patients was significantly higher than that of HD patients (p=0.001), and the survival benefit of PD over HD remained in non-diabetic patients aged less than 65 years after adjustment of covariates.

Conclusion

Survival of Korean patients initiating dialysis from 2005 to 2008 has improved over time, particularly in PD patients. In addition, survival rates among patients initiating dialysis in 2008 were different according to patients'' age and diabetes, thus we need to consider these factors when dialysis modality should be chosen.     

氯沙坦钾片联合黄葵胶囊和贝前列素钠片对腹膜透析患者腹透液蛋白丢失的影响

目的 探讨氯沙坦钾片联合黄葵胶囊和贝前列素钠片对腹膜透析患者腹透液蛋白丢失的影响。方法 选取2018年3月~2019年8月我院收治的腹膜透析患者60例作为研究对象,均给予常规透析后加用氯沙坦钾片联合黄葵胶囊和贝前列素钠片,比较治疗前与治疗后3个月血浆白蛋白及腹膜透析液中总蛋白、微量蛋白水平。结果 治疗后3个月,患者血浆白蛋白水平高于治疗前,总蛋白、微量蛋白水平低于治疗前,差异具有统计学意义（P＜0.05）。治疗后不良反应发生率为6.67%（4/60）。结论 氯沙坦钾片联合黄葵胶囊和贝前列素钠片治疗腹膜透析患者,可提高患者血浆白蛋白水平,降低腹膜透析液中总蛋白、微量蛋白水平,且不良反应轻微,对腹膜透析治疗效果具有一定促进作用。     

Comparing Survival between Peritoneal Dialysis and Hemodialysis Patients with Subclinical Peripheral Artery Disease: a 6-Year Follow-Up

Peripheral artery disease (PAD) is known to be an increased mortality risk in patients with end-stage renal disease (ESRD). The aim of this study was to compare patient survival between patients with subclinical PAD undergoing peritoneal dialysis (PD) and hemodialysis (HD). Subclinical peripheral artery was defined as an ankle-brachial index of less than 0.9. This study was conducted from April 2005, and the observation period ended on 30 June 2011. At the end of the follow-up, the status of all patients was assessed and data on mortality were obtained for the entire cohort. A total of 91 patients (61 HD and 30 PD) were included for analyses in this study. Mortality rate was 60.0% (18/30) for PD and 52.5% (32/61) for HD. Kaplan-Meier estimate demonstrate that PD patients had a higher mortality rate than those underwent HD (log-rank p = 0.0039). Cox regression model demonstrated that PD was an independent predictor for further mortality in ESRD patients with subclinical peripheral artery disease.(p = 0.012, HR: 1.776, 95% CI: 1.136-2.775). In multivariate analysis, the HD group still had a greater survival than PD group (p = 0.005, HR:1.916, 95% CI: 1.218-3.015). In patients with subclinical peripheral artery disease, the patient survival is better in HD patients as compared with PD patients.     

基于多目标模糊模式识别的腹膜透析方案选择

讨论了在腹膜透析方案的选择中的模糊性。介绍了一种多目标模糊模式识别方法,及其在腹膜透析方案选择中的应用,结果表明,这种方法与医生诊断的结果相同。该方法在腹膜透析的研究中的应用还尚属首次,为该方面的研究提供了一种新思路。并且该方法简单易用,有一定的应用前景     

尿毒症腹膜透析大鼠膈肌淋巴管新生的观察

目的观察尿毒症腹膜透析模型中膈肌淋巴管形态改变.方法首先建立5/6肾切除尿毒症腹膜透析模型.实验分组为正常组,尿毒症组,1.5%腹膜透析组及4.25%腹膜透析组.采用FTTC-dextran150腹腔注射观察隔肌淋巴管形态改变.结果在两组透析组中,观察到膈肌淋巴管管径及侧枝数目明显增加,提示存在膈肌淋巴管新生现象.结论尿毒症腹膜透析模型中出现的膈肌淋巴管新生现象,可能与腹膜超滤功能改变有关.     

Onodera's Prognostic Nutritional Index as a Risk Factor for Mortality in Peritoneal Dialysis Patients

The aim of this study was to evaluate the clinical relevance and usefulness of the Onodera''s prognostic nutritional index (OPNI) as a prognostic and nutritional indicator in peritoneal dialysis (PD) patients. Patients were divided into 3 groups based on the initial OPNI score: group A (n = 186, < 40), group B (n = 150, 40-45), and group C (n = 186, > 45). Group A was associated with a higher grade according to the Davies risk index than the other groups. Serum creatinine and albumin levels, total lymphocyte count, and fat mass increased with an increase in OPNI. According to the edema index, the correlation coefficient for OPNI was -0.284 and for serum albumin was -0.322. Similarly, according to the C-reactive protein (CRP), the correlation coefficient for OPNI was -0.117 and for serum albumin was -0.169. Multivariate analysis adjusted for age, Davies risk index, CRP, and edema index revealed that the hazard ratios for low OPNI, serum albumin, and CRP were 1.672 (P = 0.003), 1.308 (P = 0.130), and 1.349 (P = 0.083), respectively. Our results demonstrate that the OPNI is a simple method that can be used for predicting the nutritional status and clinical outcome in PD patients.     

腹膜透析患者抑郁症状的影响因素

目的:探讨腹膜透析病人抑郁及影响因素。方法:用汉密顿抑郁量表(HAMD)17项版本评估99例透析大于3个月,临床状况稳定的门诊腹膜透析病人的抑郁症状,用Charlson合并症指数评估病人合并症情况,同时调查睡眠质量、躯体症状、社会支持等因素和有关的生化指标。结果:抑郁评分均值7.37±5.38,其中10~13分11例(11.2%),14~17分9例(9%),大于17分5例(5.1%)。抑郁评分与合并症指数正相关,与躯体症状负相关,与睡眠质量负相关。抑郁评分与血清白蛋白(ALB)、血红蛋白(Hb)、尿素清除指数(Kt/Vurea)相关性无统计学意义。抑郁评分与经济收入、社会支持等呈负相关,多元线性回归分析结果表明,躯体症状、睡眠质量、肾脏疾病所致负担是抑郁的预测因子。结论:腹膜透析病人中抑郁情绪多见,躯体症状、睡眠质量、疾病所致负担等是抑郁情绪的影响因素。     

Noninfectious Complications of Peritoneal Dialysis in Korean Children: A 26-Year Single-Center Study

Purpose

The aim of this study was to investigate noninfectious complications of peritoneal dialysis (PD), including mechanical and metabolic complications, at a single center in Korea.

Materials and Methods

We analyzed data from 60 PD patients aged ≤18 years (40 boys and 20 girls) during the period between 1986 and 2012. The collected data included gender, age, causes of PD, incidence of noninfectious complications, and treatment for the complications.

Results

The mean duration of PD therapy was 28.7±42.1 months (range 1-240 months). The most common cause of end-stage renal disease was glomerular disease (43.3%). There were no statistically significant differences between patients with and without mechanical complications regarding gender, age at the start of PD, and total duration of PD. Outflow failure was the most common catheter-related complication (14.3%), followed by leakage (10.0%) and hernia (8.6%). Metabolic complications, such as hyperglycemia and hypokalemia, were observed in three of 16 patients. The frequency of noninfectious complications of PD in our study was comparable with those in previous pediatric studies. PD was switched to hemodialysis (HD) in only three patients.

Conclusion

Our results indicate that noninfectious complications of PD are common, though they hardly lead to catheter removal or HD in pediatric patients on PD.     

腹膜透析病人的焦虑和抑郁水平与其病情变化的相关分析

目的:探讨腹膜透析病人情绪障碍,即焦虑症状和抑郁症状的发生情况,以及与透析相关因素的关系.方法:88例腹膜透析病人,使用Hamilton焦虑量表和Hamilton抑郁量表评估其情绪状况,同时测定其营养状况、残余肾功能和透析充分性、以及炎症水平,记录心脑血管事件发生情况等.结果:本组腹膜透析病人焦虑症状的发生率为44.3%,抑郁症状的发生率为56.8%.具有糖尿病和心脑血管病史者的Hamilton焦虑评分和抑郁评分高于无此类病史者(P<0.05).SGA评分较高的病人Hamilton焦虑评分和抑郁评分也较高;焦虑评分和抑郁评分较高的病人,其血清白蛋白水平、蛋白质摄入水平、体重指数、上臂中段肌肉面积和脂肪面积均较低(r=0.22～0.60,P<0.05或P<0.01).结论:腹膜透析病人焦虑症状和抑郁症状的发生率较高,焦虑症状和抑郁症状与心脑血管系统疾病和糖尿病相关,并可能与营养不良的发生存在一定的关系.