CAJ | 학술논문

目的比较腹膜透析患者不同透析剂量的临床疗效.方法横断面调查西安交通大学医学院第一附属医院腹膜透析中心透析超过3个月但处于稳定状态的腹膜透析患者,根据透析剂量不同分为3组,A组≤4000ml,B组≤6000ml,C组≥8000ml.比较3组患者的透析充分性、血浆白蛋白、校正的蛋白分解率、24 h腹透液蛋白定量、体表面积、用尿尿素氮清除率与尿肌酐清除率的均值计算肾小球滤过率.结果 3组患者总尿素氮清除指数和总肌酐清除率比较差异无统计学意义(P>0.05);A组患者腹膜Kt/V和腹膜总肌酐清除率与B、C组比较差异有统计学意义(P<0.01);c组患者残肾Kt/V和残肾总肌酐清除率及肾小球滤过率与A、B组比较差异有统计学意义(P<0.01);A组患者白蛋白与C组比较差异有统计学意义(P<0.15);3组间蛋白分解率比较差异无统计学意义(P>0.05).A组患者24 h腹透液蛋白定量与C组比较差异有统计学意义(P<0.05).A组患者体表面积与B、C组比较差异有统计学意义(P<0.0).A组患者促红素用量及医药费用最低.结论 (1)大多数患者使用6000 ml或6000 ml以下的透析剂量可以达到充分透析;(2)残肾功能好,体表面积小的患者,小剂量透析可以维持良好的营养状况,医疗费用越低;(3)透析时间长、残肾差、体表面积大的患者需要更高透析剂量才能维持充分透析,但腹膜透析液蛋白丢失增多,蛋白摄入不足,残肾对毒素清除减少可能使营养状况恶化.
목적 비교복막투석환자불동투석제량적림상료효.방법 횡단면조사서안교통대학의학원제일부속의원복막투석중심투석초과3개월단처우은정상태적복막투석환자,근거투석제량불동분위3조,A조≤4000ml,B조≤6000ml,C조≥8000ml.비교3조환자적투석충분성、혈장백단백、교정적단백분해솔、24 h복투액단백정량、체표면적、용뇨뇨소담청제솔여뇨기항청제솔적균치계산신소구려과솔.결과 3조환자총뇨소담청제지수화총기항청제솔비교차이무통계학의의(P>0.05);A조환자복막Kt/V화복막총기항청제솔여B、C조비교차이유통계학의의(P<0.01);c조환자잔신Kt/V화잔신총기항청제솔급신소구려과솔여A、B조비교차이유통계학의의(P<0.01);A조환자백단백여C조비교차이유통계학의의(P<0.15);3조간단백분해솔비교차이무통계학의의(P>0.05).A조환자24 h복투액단백정량여C조비교차이유통계학의의(P<0.05).A조환자체표면적여B、C조비교차이유통계학의의(P<0.0).A조환자촉홍소용량급의약비용최저.결론 (1)대다수환자사용6000 ml혹6000 ml이하적투석제량가이체도충분투석;(2)잔신공능호,체표면적소적환자,소제량투석가이유지량호적영양상황,의료비용월저;(3)투석시간장、잔신차、체표면적대적환자수요경고투석제량재능유지충분투석,단복막투석액단백주실증다,단백섭입불족,잔신대독소청제감소가능사영양상황악화.
Objective To compare the clinical effect in PD patients with different doses. Methods Cross- sectional study was performed in this study. All the PD patients were divided into 3 groups according to dialysis dose: A (dialysis dose was less than 4000 ml/d), B (dialysis dose was less than 6000 ml/d) ,and C (dialysis dose was more than 6000 ml/d). The data of diallysis adequacy, serum protein, GFR and cost of the peritoneal dislysis patients was contrasted in the 3 groups. Results There are no significant difference in total Kt/V and ccr in the 3 groups. PKt/V and pccr in group A is significant lower than that in group B and group C, ukt/v,uccr and GFR in group A are higher than that in group B and C. Serum protein in group A is better than that in group C, the protein excretion in dialysate per day in group A is lower than that in group C. The group A has the cheapest clinical cost in all patients. Conclusios Most patients get adequacy dialy-sis by dose of 6000 ml or less than 6000 ml. The better of residual renal function, the better of clinical effect and cost less money. The more loss of protein in dislysate perhaps cause the low protein in serum.