目的 比较采用日间非卧床腹膜透析(DAPD)患者与血液透析(HD)患者之间的长期临床疗效,探讨适合中国人的长期透析方法.方法 选自我院门诊或住院终末期肾衰竭患者46例,随机分成A、B两组,A组24例,B组22例,A组采用HD[包括常规HD、血液透析滤过(HDF)、血液灌流(HP)等]方法,每周透析3次、透析时间12～ 15 h/周；B组采用DAPD方法,每天透析液剂量6～8L,每袋腹膜透析液交换时间为3～4h,夜间干腹.随后长期监测并比较两组患者的透析充分性,即尿素清除指数(Kt/V),营养状况包括营养不良发生率(SGA)、血清白蛋白(sALB),并发症控制情况包括血红蛋白(Hb)、二氧化碳结合力( C02 CP)、血钾(K+)、血钙(Ga2+)、血磷(p-)、游离甲状旁腺激素(iPTH)及血压(平均动脉压)、感染发生率、就业率、年医疗费用,并采用Baahel指数(BI)进行日常生活能力的评价和汉密尔顿抑郁量表(HAMD)进行抑郁程度的评分.结果 A、B两组患者均可以长期维持透析生存,且在透析充分性( (Kt/V)、营养状况(SGA、sALB)、并发症控制情况(Hb、CO2CP、K+、Ga2、p-、平均动脉压)、感染发生率等方面比较差异均无统计学意义(P均＞0.05)；透析1年时,B组患者在尿量、BI和就业率大于A组[两组分别为:尿量:(274±102) ml与(205±86) ml,P=0.017；BI:82±13与73±11,P=0.044；就业率:40.9％与12.5％,P=0.044)],超滤量、iPTH、HAMD和年医疗费用小于A组[两组分别为:超滤量:( 1162±124) ml与(1542±136) ml,P＜0.001；iPTH:(77.5±12.7)ng/L与(104.4±11.3) ng/L,P＜0.001；HAMD:8 ±:3与18 ±4,P＜0.001；年医疗费用:(7.67±1.48)万元与(11.35±2.52)万元,P＜0.001)]；透析5年时,B组患者BI、就业率均大于A组[两组分别为:BI:80±13与71±14,P=0.029；就业率:36.4％与8.3％,P=0.032],iPTH、HAMD和年医疗费用均小于A组[两组分别为:iPTH:(83.8±13.4) ng/L与(123.8±12.4) ng/L,P＜0.001；HAMD:8±2与19±2,P＜0.001；年医疗费用(10.32±1.64)万元与(13.47±2.38)万元,P＜0.001],生存率、透析维持时间方面比较差异均无统计学意义[两组分别为:生存率:70.8％与86.4％,P=0.289；透析维持时间:(56.82±6.13)个月与(57.35±6.30)个月,P=0.774].结论 长期行DAPD方法的患者与普通HD患者相比,在透析的充分性、营养状况的维持、并发症的控制、血压的调节、降低感染率等方面均有满意的临床疗效,且在减轻透析患者抑郁程度、保证更好的生活质量、缓解经济负担等方面更有优势.
目的 比較採用日間非臥床腹膜透析(DAPD)患者與血液透析(HD)患者之間的長期臨床療效,探討適閤中國人的長期透析方法.方法 選自我院門診或住院終末期腎衰竭患者46例,隨機分成A、B兩組,A組24例,B組22例,A組採用HD[包括常規HD、血液透析濾過(HDF)、血液灌流(HP)等]方法,每週透析3次、透析時間12～ 15 h/週；B組採用DAPD方法,每天透析液劑量6～8L,每袋腹膜透析液交換時間為3～4h,夜間榦腹.隨後長期鑑測併比較兩組患者的透析充分性,即尿素清除指數(Kt/V),營養狀況包括營養不良髮生率(SGA)、血清白蛋白(sALB),併髮癥控製情況包括血紅蛋白(Hb)、二氧化碳結閤力( C02 CP)、血鉀(K+)、血鈣(Ga2+)、血燐(p-)、遊離甲狀徬腺激素(iPTH)及血壓(平均動脈壓)、感染髮生率、就業率、年醫療費用,併採用Baahel指數(BI)進行日常生活能力的評價和漢密爾頓抑鬱量錶(HAMD)進行抑鬱程度的評分.結果 A、B兩組患者均可以長期維持透析生存,且在透析充分性( (Kt/V)、營養狀況(SGA、sALB)、併髮癥控製情況(Hb、CO2CP、K+、Ga2、p-、平均動脈壓)、感染髮生率等方麵比較差異均無統計學意義(P均＞0.05)；透析1年時,B組患者在尿量、BI和就業率大于A組[兩組分彆為:尿量:(274±102) ml與(205±86) ml,P=0.017；BI:82±13與73±11,P=0.044；就業率:40.9％與12.5％,P=0.044)],超濾量、iPTH、HAMD和年醫療費用小于A組[兩組分彆為:超濾量:( 1162±124) ml與(1542±136) ml,P＜0.001；iPTH:(77.5±12.7)ng/L與(104.4±11.3) ng/L,P＜0.001；HAMD:8 ±:3與18 ±4,P＜0.001；年醫療費用:(7.67±1.48)萬元與(11.35±2.52)萬元,P＜0.001)]；透析5年時,B組患者BI、就業率均大于A組[兩組分彆為:BI:80±13與71±14,P=0.029；就業率:36.4％與8.3％,P=0.032],iPTH、HAMD和年醫療費用均小于A組[兩組分彆為:iPTH:(83.8±13.4) ng/L與(123.8±12.4) ng/L,P＜0.001；HAMD:8±2與19±2,P＜0.001；年醫療費用(10.32±1.64)萬元與(13.47±2.38)萬元,P＜0.001],生存率、透析維持時間方麵比較差異均無統計學意義[兩組分彆為:生存率:70.8％與86.4％,P=0.289；透析維持時間:(56.82±6.13)箇月與(57.35±6.30)箇月,P=0.774].結論 長期行DAPD方法的患者與普通HD患者相比,在透析的充分性、營養狀況的維持、併髮癥的控製、血壓的調節、降低感染率等方麵均有滿意的臨床療效,且在減輕透析患者抑鬱程度、保證更好的生活質量、緩解經濟負擔等方麵更有優勢.
목적 비교채용일간비와상복막투석(DAPD)환자여혈액투석(HD)환자지간적장기림상료효,탐토괄합중국인적장기투석방법.방법 선자아원문진혹주원종말기신쇠갈환자46례,수궤분성A、B량조,A조24례,B조22례,A조채용HD[포괄상규HD、혈액투석려과(HDF)、혈액관류(HP)등]방법,매주투석3차、투석시간12～ 15 h/주；B조채용DAPD방법,매천투석액제량6～8L,매대복막투석액교환시간위3～4h,야간간복.수후장기감측병비교량조환자적투석충분성,즉뇨소청제지수(Kt/V),영양상황포괄영양불량발생솔(SGA)、혈청백단백(sALB),병발증공제정황포괄혈홍단백(Hb)、이양화탄결합력( C02 CP)、혈갑(K+)、혈개(Ga2+)、혈린(p-)、유리갑상방선격소(iPTH)급혈압(평균동맥압)、감염발생솔、취업솔、년의료비용,병채용Baahel지수(BI)진행일상생활능력적평개화한밀이돈억욱량표(HAMD)진행억욱정도적평분.결과 A、B량조환자균가이장기유지투석생존,차재투석충분성( (Kt/V)、영양상황(SGA、sALB)、병발증공제정황(Hb、CO2CP、K+、Ga2、p-、평균동맥압)、감염발생솔등방면비교차이균무통계학의의(P균＞0.05)；투석1년시,B조환자재뇨량、BI화취업솔대우A조[량조분별위:뇨량:(274±102) ml여(205±86) ml,P=0.017；BI:82±13여73±11,P=0.044；취업솔:40.9％여12.5％,P=0.044)],초려량、iPTH、HAMD화년의료비용소우A조[량조분별위:초려량:( 1162±124) ml여(1542±136) ml,P＜0.001；iPTH:(77.5±12.7)ng/L여(104.4±11.3) ng/L,P＜0.001；HAMD:8 ±:3여18 ±4,P＜0.001；년의료비용:(7.67±1.48)만원여(11.35±2.52)만원,P＜0.001)]；투석5년시,B조환자BI、취업솔균대우A조[량조분별위:BI:80±13여71±14,P=0.029；취업솔:36.4％여8.3％,P=0.032],iPTH、HAMD화년의료비용균소우A조[량조분별위:iPTH:(83.8±13.4) ng/L여(123.8±12.4) ng/L,P＜0.001；HAMD:8±2여19±2,P＜0.001；년의료비용(10.32±1.64)만원여(13.47±2.38)만원,P＜0.001],생존솔、투석유지시간방면비교차이균무통계학의의[량조분별위:생존솔:70.8％여86.4％,P=0.289；투석유지시간:(56.82±6.13)개월여(57.35±6.30)개월,P=0.774].결론 장기행DAPD방법적환자여보통HD환자상비,재투석적충분성、영양상황적유지、병발증적공제、혈압적조절、강저감염솔등방면균유만의적림상료효,차재감경투석환자억욱정도、보증경호적생활질량、완해경제부담등방면경유우세.
Objective To explore the long-term dialysis therapies suitable for Chinese patients by comparison of the long-term clinical effect of daily ambulatory peritoneal dialysis ( DAPD ) and hemodialysis (HD) on patients with end-stage renal failure.Methods Forty-six outpatients and inpatients with end-stage renal failure were enrolled from our hospital and divided into group A (24 patients) and group B (22 patients) randomly.Participants in group A received HD treatmant,including conventional HD,hemodiafiltration (HDF),hemoperfusion (HP),etc.For three times in total 12 - 15 h each week;patients in group B received DAPD with a daily dialysate dose of 6 - 8 L and a replacement in every 3 - 4 h for each bag of peritoneal dialysate,as well as a break overnight.The subsequent long-term monitoring was performed,and the following variables were compared for the patients in these two groups:sufficiency of dialysis (i.e.Kt/V),nutritional status [ including SGA and sALB ),complication control ( including Hb,CO2CP,K+,Ca2+,P-,iPTH and blood pressure (MAP) ],infection incidence,employment rate and annual medical expense.The evaluation on daily activities of living was also performed using Barthel Index (BI) and the presence of depressive dsymptoms was assessed by HAMD.Results Patients in both group A and group B could survive under long-term dialysis,and there was no statistically significant difference in sufficiency of dialysis (Kt/V),nutritional status (SGA and sALB ),complication control ( Hb,CO2 CP,K +,Ca2 +,P -,and MAP) and infection incidence ( P ＞ 0.05 ).One year after dialysis,the urine volume [ (274 ± 102) ml vs.( 205 ± 86 ) ml,P =0.017 ],BI ( 82 ± 13 vs.73 ± 11,P =0.044) and employment rate (40.9％ vs.12.5％,P=0.044) of the patients in group B were higher than those of the patients in group A,but the ultra-filtration volume [ ( 1162 ± 124 ) ml vs.( 1542±136 ) ml,P ＜ 0.001 ],iPTH [ (77.5 ± 12.7 ) ng/L vs.( 104.4±11.3 ) ng/L,P ＜ 0.001 ],HAMD ( 8 ± 3 vs.18 ± 4,P ＜ 0.001 ) and annual medical expense [ (7.67±1.48 ) ng/L vs.( 11.35 ± 2.52 ) ng/L thousand yuan,P ＜ 0.001 ] were lower than those of the patients in group A.Five years after dialysis,B1 ( 80 ± 13vs.71 ± 14,P =0.029 ) and employment rate ( 36.4％ vs.8.3％,P =0.032 ) in group B were greater than those in group A,while iPTH [ (83.8 ± 13.4) ng/L vs.( 123.8 ± 12.4) ng/L,P ＜ 0.001 ],HAMD ( 8±2 vs.19 ± 2,P ＜ 0.001 ),and annual medical expense [ ( 10.32±1.64 ) thousand yuan vs.( 13.47 ±2.38 ) thousand yuan,P ＜ 0.001 ] were lower than those in group A,and there was no statistically significant difference in survival rate (70.8％ vs.86.4％,P=0.289) and dialysis duration [ ( 56.82 ± 6.13 ) mouths vs.(57.35 ± 6.30) months,P =0.774 ] between the two groups ( P ＞ 0.05 ).Conclusion The comparison between the patients treated by long-term DAPD and those treated by conventional HD shows that DAPD has a satisfactory clinical effect in the aspects of sufficiency of dialysis,maintainence of nutritional status,control of complications,regulation of blood pressure and decrease of infection incidence,and it is also superior in reducing depressive symptoms,ensuring better quality of life and mitigating economic burden of patients.
