腹膜透析治疗急性肾损伤——国际腹膜透析协会指南解读

腹膜透析已广泛应用于急性肾损伤（acute kidney injury,AKI）治疗,包括在资源匮乏地区和高收入国家。该文将2020年国际腹膜透析协会关于腹膜透析治疗AKI指南的要点进行了解读,从腹膜透析治疗AKI效果、导管通路、透析溶液、透析处方与溶质清除目标、并发症5个方面介绍了腹膜透析治疗AKI的核心原则及相关进展,为临床治疗决策提供借鉴与参考。     

关于2005年ISPD腹膜透析相关感染诊治指南的几点思考

近几年来,随着腹膜透析技术的日渐成熟,特别是上世纪90年代以来,腹膜透析连接系统的改进大大降低了腹膜炎的发生,使得这一技术得以广泛开展。在全球范围内,尤其是亚太地区接受腹膜透析治疗的终末期肾脏病患者越来越多。尽管如此,腹膜炎依然是腹膜透析治疗的首要并发症。它可造成技术失败和住院，和患者的死亡密切相关，     

NKF-K／DOQI腹膜透析充分性的临床实践指南

第六部分 促进达到腹膜透析处方剂量的策略 应及时发现和纠正因使腹膜透析未能达到处方剂量的患者相关因素，这些因素包括：①未依从处方；②对完全依从处方的重要性缺乏理解；③取样和收集错误。     

以国际指南为基础的腹膜透析患者培训

腹膜透析（简称腹透）患者的培训和再培训应受到医护人员的充分重视。患者接受初始培训是开始顺利腹透的重要保证。2006年国际腹透学会（International Society of Peritoneal Dialysis,ISPD）首次发表了腹透培训指南[1]（下文称培训指南）,明确指出护士应依据指南推荐,应用成人学习理论,     

腹膜透析充分性指标探讨

目的在氮平衡的基础上评价Kt/V这一经典的透析充分性评估指标在腹膜透析中的价值,探讨腹膜透析充分性的最佳评估指标.方法在氮平衡的基础上推算持续性不卧床腹膜透析(CAPD)患者的理论透析剂量及透析指数(DI),并进一步推算氮平衡状态下的Kt/V计算公式;计算溶质转运指数(SRI).比较透析指数(DI)、溶质清除指数(Kt/V)、溶质转运指数(SRI)三者在评估透析充分性方面的优缺点.结果溶质清除指数(Kt/V)受饮食蛋白的摄入量及体重的影响,我们不能用同一个Kt/V值标准来评估不同条件下CAPD患者的透析充分状况.在CAPD状态下,溶质转运指数(SRI)与Kt/V反映的数据是相同的,它反映的是溶质的清除量与该溶质在身体中总的含量之比.透析指数(DI)可以反映在达到目标血尿素氮(BUN)水平时不同体重、不同蛋白质摄入(DPI)患者达到氮平衡状态时所需要的透析剂量,当不存在蛋白质摄入不足的情况下,它可以从氮平衡的角度反映透析的充分性.结论对于临床处于稳定状态的CAPD患者,用透析指数(DI)综合蛋白摄入量(DPI)来评估其透析充分性较单纯目标尿素溶质清除指数Kt/V值及溶质转运指数(SRI)更为客观可靠.     

基于艾考糊精透析液的腹膜透析治疗进展CSCD

艾考糊精通过其类似“胶体”渗透压的机制,应用于腹膜透析的长保留阶段并形成有效的超滤。在经典的基于艾考糊精透析液的治疗方案基础上,出现了每日单次使用艾考糊精透析液、每日2次使用艾考糊精透析液、艾考糊精与葡萄糖腹膜透析液联合等多种治疗方案,适用于不同的临床状况中。艾考糊精腹膜透析液的应用,有助于控制慢性心力衰竭,改善或维持心室结构。应用基于艾考糊精透析液的治疗方案将会有效地提升我国腹膜透析治疗的水平。     

NKF-K/DOQI腹膜透析充分性的临床实践指南第三部分腹膜透析剂量的测定

总K/Vurea和Ccr的精确测定要求收集和分析尿液、透析液和血清的方法重复性好及结果可靠。因存在葡萄糖的干扰，对透析液肌酐浓度的检测必须进行校正。可靠的测定需在治愈腹膜炎1个月以后进行。标本收集的依从性非常重要。例如，1名患者每日排尿≥3次，收集24h尿就足够。而对于每日排尿次数少的患者，要求收集48h标本。对于CAPD患者，可在任何方便的时间获得血清标本。而对NIPD的患者，采样必须在白天干腹的中点时间。对CCPD的患者，采取血清标本必须在白天腹膜透析液留置的中点时进行。     

NKF-K/DOQI腹膜透析充分性的临床实践指南

第一部分 透析的开始 背景在决定何时开始进行透析方面有两条指南，它们是决定临床预后的两个独立的影响因素。一是以肾功能的情况（由每周的Kt/Vurea来衡量）为基础的，二是取决于患的营养状况，后在K／DOQI慢性肾功能衰竭的临床实践指南中进行了阐述。[第一段]     

居家腹膜透析患者的护理体会

腹膜透析是治疗尿毒症的重要方法之一，在治疗过程中，尤其是居家腹膜透析后，如能尽早实施有效的护理，可有效预防腹膜透析造成的腹膜炎等并发症的发生。体会如下。     

氨基酸腹膜透析对腹膜透析患者生化指标、透析效能及营养状况的影响

目的探讨氨基酸腹膜透析对腹膜透析患者透析效能和营养状况的影响。方法采用回顾性研究方法,选取2017年8月至2019年8月同济大学附属杨浦医院收治的腹膜透析患者40例,依据不同的腹膜透析液分为氨基酸腹膜透析组和葡萄糖腹膜透析组,每组各20例。葡萄糖腹膜透析组患者应用1. 5%葡萄糖腹膜透析液进行透析,氨基酸腹膜透析组患者接受0. 491%氨基酸腹膜透析液进行透析,比较两组患者的总胆固醇(Ch)、转铁蛋白(Tri)、高密度脂蛋白(HDL)、二氧化碳结合力(CO2-cp)等一般生化指标、血肌酐(Ccr),透析液尿素-肌酐(R-Ccr)、腹膜-残余肾总尿素(Kt/v)等透析效能指标和前白蛋白(Alb)、转铁蛋白(TF)、前白蛋白(PA)等营养状况指标。结果氨基酸腹膜透析组患者治疗前后的Ch、Tri、HDL、CO2-cp水平比较,差异均无统计学意义(P 0. 05)。葡萄糖腹膜透析组患者治疗后的Ch、Tri水平高于治疗前(P 0. 05);但治疗前后的HDL、CO2-cp水平比较,无显著差异(P 0. 05)。相较于葡萄糖腹膜透析组,在治疗后氨基酸腹膜透析组患者Ch、Tri水平均明显较低(P 0. 05)。氨基酸腹膜透析组患者治疗后较治疗前的Ccr、R-Ccr、Kt/v降低幅度均显著高于葡萄糖腹膜透析组(P 0. 05)。氨基酸腹膜透析组患者治疗前Alb、TF、PA分别为(38. 7±6. 8) g/L、(2. 53±0. 36) g/L、(461. 4±70. 3) g/L,治疗后Alb、TF、PA分别为(41. 5±3. 8) g/L、(2. 86±0. 13) g/L、(479. 6±75. 2) g/L;葡萄糖腹膜透析组患者治疗前Alb、TF、PA分别为(37. 7±4. 6) g/L、(2. 50±0. 46) g/L、(460. 1±76. 3) g/L,治疗后Alb、TF、PA分别为(38. 6±5. 7) g/L、(2. 40±0. 52) g/L、(351. 6±52. 4) g/L。氨基酸腹膜透析组患者治疗后的Alb、TF、PA水平均显著高于治疗前,葡萄糖腹膜透析组治疗后的TF、PA水平显著低于治疗前(P 0. 05)。治疗后,氨基酸腹膜透析组患者的Alb、TF、PA水平均显著高于葡萄糖腹膜透析组(P 0. 05)。结论氨基酸腹膜透析能够有效改善腹膜透析患者一般生化指标、透析效能和营养状况。     

The Needs of Older Patients for Peritoneal Dialysis: Training and Support at Home

Chronic kidney disease (CKD) in all its stages has become an important problem for older patients, stage 3 – 5 is expected to happen in 25 to 30% of the population, and a higher prevalence can be found in residential care and nursing homes, affecting the demand for patient education. Although older patients are able and keen to learn, there are specific needs that must be addressed. The focus of this paper is to review the demands to train and maintain older patients on peritoneal dialysis (PD) at home.     

A Global Overview of the Impact of Peritoneal Dialysis First or Favored Policies: An Opinion

Given the ever-increasing burden of end-stage renal disease (ESRD) in a global milieu of limited financial and health resources, interested parties continue to search for ways to optimize dialysis access. Government and payer initiatives to increase access to renal replacement therapies (RRTs), particularly peritoneal dialysis (PD) and hemodialysis (HD), may have meaningful impacts from clinical and health-economic perspectives; and despite similar clinical and humanistic outcomes between the two dialysis modalities, PD may be the more convenient and resource-conscious option. This review assessed country-specific PD-First/Favored policies and their associated background, implementation, and outcomes. It was found that barriers to policy-implementation are broadly associated with government policy, economics, provider or healthcare professional education, modality-related factors, and patient-related factors. Notably, the success of a given country''s PD-Favored policy was inversely associated with the extent of HD infrastructure. It is hoped that this review will provide a foundation across countries to share lessons learned during the development and implementation of PD-First/Favored policies.     

The Risk Factors and the Impact of Hernia Development on Technique Survival in Peritoneal Dialysis Patients: A Population-Based Cohort Study

♦ Objectives:

There is a lack of consensus on the risk factors for hernia formation, and the impact on peritoneal dialysis (PD) survival has seldom been studied.

♦ Methods:

This was a population-based study and all collected data were retrieved from the National Health Insurance Research Database of Taiwan. Patients who commenced PD between January 1998 and December 2006 were screened for inclusion. Multiple logistic regression and Cox proportional hazards models were applied to estimate the predictors for hernia formation and determine the predictors of PD withdrawal.

♦ Results:

A total of 6,928 PD patients were enrolled and followed until December 2009, with 631 hernia events and 391 hernioplasties being registered in 530 patients (7.7%). The incidence rate was 0.04 hernias/patient/year. Longer PD duration (per 1 month increase, hazard ratio (HR) 1.019) and history of mitral valve prolapse (MVP) (HR 1.584) were independent risk factors for hernia formation during PD, and female gender (HR 0.617) was a protective factor. On the other hand, there were 4,468 PD withdrawals, with cumulative incidence rates of 41% at 1 year, 66% at 3 years, and 82% at 5 years. Independent determinants for cumulative PD withdrawal included hernia formation during PD (HR 1.154), age (per 1 year increase, HR 1.014), larger dialysate volume (per 1 liter increase, HR 0.496), female gender (HR 0.763), heart failure (HR 1.092), hypertension (HR 1.207), myocardial infarction (HR 1.292), chronic obstructive pulmonary disease (COPD) (HR 1.227), cerebrovascular accident (CVA) (HR 1.364), and history of MVP (HR 0.712)

♦ Conclusions:

Prolonged PD duration was a risk factor for hernia formation, and female gender was protective. Hernia formation during PD therapy may increase the risk of PD withdrawal.     

The Negative Impact of Early Peritonitis on Continuous Ambulatory Peritoneal Dialysis Patients

♦ Background: Peritonitis rate has been reported to be associated with technique failure and overall mortality in previous literatures. However, information on the impact of the timing of the first peritonitis episode on continuous ambulatory peritoneal dialysis (CAPD) patients is sparse. The aim of this research is to study the influence of time to first peritonitis on clinical outcomes, including technique failure, patient mortality and dropout from peritoneal dialysis (PD).♦ Methods: A retrospective observational cohort study was conducted over 10 years at a single PD unit in Taiwan. A total of 124 patients on CAPD with at least one peritonitis episode comprised the study subjects, which were dichotomized by the median of time to first peritonitis into either early peritonitis patients or late peritonitis patients. Cox proportional hazard model was used to analyze the correlation of the timing of first peritonitis with clinical outcomes.♦ Results: Early peritonitis patients were older, more diabetic and had lower serum levels of creatinine than the late peritonitis patients. Early peritonitis patients were associated with worse technique survival, patient survival and stay on PD than late peritonitis patients, as indicated by Kaplan-Meier analysis (log-rank test, p = 0.04, p < 0.001, p < 0.001, respectively). In the multivariate Cox regression model, early peritonitis was still a significant predictor for technique failure (hazard ratio (HR), 0.54; 95% confidence interval (CI), 0.30 - 0.98), patient mortality (HR, 0.34; 95% CI, 0.13 - 0.92) and dropout from PD (HR, 0.50; 95% CI, 0.30 - 0.82). In continuous analyses, a 1-month increase in the time to the first peritonitis episode was associated with a 2% decreased risk of technique failure (HR, 0.98; 95% CI, 0.97 - 0.99), a 3% decreased risk of patient mortality (HR, 0.97; 95% CI, 0.95 - 0.99), and a 2% decreased risk of dropout from PD (HR, 98%; 95% CI, 0.97 - 0.99). Peritonitis rate was inversely correlated with time to first peritonitis according to the Spearman analysis (r = -0.64, p < 0.001).♦ Conclusions: Time to first peritonitis is significantly correlated with clinical outcomes of peritonitis patients with early peritonitis patients having poor prognosis. Patients with shorter time to first peritonitis were prone to having a higher peritonitis rate.     

Dialysis disequilibrium syndrome: an unusual cause of respiratory failure in the medical intensive care unit

We describe a case of the dialysis disequilibrium syndrome (DDS) that was marked by the rapid onset of cerebral edema and the subsequent development of acute respiratory failure. The patient was treated successfully with a combination of mechanical hyperventilation and mannitol. The clinical presentation, pathogenesis, prevention and treatment of the entity are discussed. Received: 24 June 1999 Final revision received: 19 November 1999 Accepted: 20 January 2000     

Evaluating the Beta version of the International Classification for Nursing Practice for domain completeness, applicability of its axial structure and utility in clinical practice: a Norwegian project

The purpose of this Norwegian project was to evaluate the International Classification for Nursing Practice (ICNP) Beta version for domain completeness, applicability of its axial structure and utility in clinical practice. A subset of terms addressing the areas of circulation and elimination were abstracted from the nursing records of a cardiac intensive care unit and a nursing home. Abstracted terms were mapped to terms in the ICNP. In the ICNP, the same or similar terms were found for 47% of the documented circulation terms and 69% of the documented elimination terms that addressed nursing phenomena. For nursing interventions, 27% of the documented circulation terms and 35% of the documented elimination terms mapped to the ICNP. The research team encountered difficulty in coding terms with the ICNP that expressed patients' perspectives, preferences, behaviours and experiences, and terms that represented signs-and-symptoms. Recommendations for further development of the ICNP include improvement in granularity, precision and conceptual definitions of terms; inclusion of time-related terms for representing nursing phenomena; and an easier method for navigating around the ICNP.     

国内应用脊髓损伤神经学分类标准(ASIA)现状初步分析

目的了解国内应用美国脊柱损伤委员会脊髓损伤神经学分类标准（简称“ASIA”）使用现状。方法登陆“中国知网”网站（http：／／www．cnki．net），在1979～2006全部中国期刊全文数据库，模糊匹配检索词为“脊髓损伤”与“ASIA”进行检索。结果共检索到164篇，去除不相关及重复文献，共检索到与本研究相关文献共140篇。结论ASIA标准在国内得到广泛应用，国内学者的研究为ASIA标准的完善提出了自己的见解；国内在对ASIA标准的使用上也存在一定程度的混乱及滞后。