CAJ | 학술논문

目的：研究并探讨终末期肾病患者非卧床腹膜透析不同透析模式的临床疗效。方法通过对终末期肾病腹膜透析患者残肾功能较好的患者采取不同的透析模式，将患者随机分为两组：日间小剂量递增组（26例），透析液总量每日4.5～8 L，夜间不留腹；持续标准透析剂量组（24例），每日透析液量8 L，夜间留腹，比较两组研究开始与终点的营养指标、血生化指标、透析充分性、残肾功能、胱抑素 C。结果两组患者至观察终点血浆白蛋白、24 h尿量、残肾功能、胱抑素C比较差异有统计学意义（P＜0.05）。两组血K＋、血P3＋、二氧化碳结合力（CO2CP）、24 h超滤量、透析充分性指标每周总尿素氮清除率（Kt/V）、每周总肌苷清除率（Ccr），比较差异无统计学意义（P＞0.05），两组置管后1个月内导管堵管、渗漏发生率比较差异无统计学意义（P＞0.05）。两组的每日透析液总量和透析时间均有统计学差异（P＜0.05）。结论（1）残肾功能较好的终末期肾病患者，置管后早期采用日间小剂量递增式腹膜透析可使患者尽早得到治疗，并且不增加早期导管堵管与渗漏；（2）初期应用小剂量递增式腹膜透析可减少残肾功能的丢失，并维持相对较好的营养状况。（3）与持续标准剂量组比较，小剂量递增式腹膜透析可减少腹膜透析初期透析液的用量。
목적：연구병탐토종말기신병환자비와상복막투석불동투석모식적림상료효。방법통과대종말기신병복막투석환자잔신공능교호적환자채취불동적투석모식，장환자수궤분위량조：일간소제량체증조（26례），투석액총량매일4.5～8 L，야간불류복；지속표준투석제량조（24례），매일투석액량8 L，야간류복，비교량조연구개시여종점적영양지표、혈생화지표、투석충분성、잔신공능、광억소 C。결과량조환자지관찰종점혈장백단백、24 h뇨량、잔신공능、광억소C비교차이유통계학의의（P＜0.05）。량조혈K＋、혈P3＋、이양화탄결합력（CO2CP）、24 h초려량、투석충분성지표매주총뇨소담청제솔（Kt/V）、매주총기감청제솔（Ccr），비교차이무통계학의의（P＞0.05），량조치관후1개월내도관도관、삼루발생솔비교차이무통계학의의（P＞0.05）。량조적매일투석액총량화투석시간균유통계학차이（P＜0.05）。결론（1）잔신공능교호적종말기신병환자，치관후조기채용일간소제량체증식복막투석가사환자진조득도치료，병차불증가조기도관도관여삼루；（2）초기응용소제량체증식복막투석가감소잔신공능적주실，병유지상대교호적영양상황。（3）여지속표준제량조비교，소제량체증식복막투석가감소복막투석초기투석액적용량。
Objective To research and discuss the clinical efficacy of different peritoneal dialysis pattern in end-stage renal disease. Methods By adopting different mode of peritoneal dialysis in patients with end-stage renal disease, patients was divided into two groups random, one is small dose escalation group which dialysate volume is total 4.5-8 L at daytime, the other one is standard dialysis dose group which dialysate volume is total 8 L at all day, compare two groups of nutrition index, biochemical index, dialysis adequacy, residual renal function, Cys-c. Results There were observed statistically significance between the two groups patients of the plasma albumin, 24 hours urine, residual renal function, cys-c (P<0.05). There was no statistical significance between the two groups of blood potassium, phosphorus, CO2CP, 24 hours ultrafiltration, dialysis adequacy index-weekly total Kt/V, and weekly total Cr clearance (P>0.05). After catheter put into the patients within one month, the tube plugging, leakage rate has no statistical significance (P>0.05). Conclusion (1) The patients with end-stage renal disease who have good residual renal function can be treated timely with small doses of daytime incremental peritoneal dialysis in the early days, and do not increase the early catheter tube jam and leakage. (2) The small doses of daytime incremental peritoneal dialysis used in the early stage can reduce the loss of residual renal function, maintain a relatively good nutritional status. (3) Compared with standard dialysis dose group, it can reduce the dosage of the peritoneal dialysis in the early stage.