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 increasing ventral movement on the small solutes transport during peritoneal dialysis

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 4hr and D/P value for creatinine at the 2hr 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.