CAJ | 학술논문

目的探讨自动化腹膜透析在初置管腹膜透析患者过渡期的运用及对患者远期腹膜炎发生率的影响.方法将在本腹膜透析中心进行腹膜透析置管的患者随机分为间歇性腹膜透析组(IPD组)和自动化腹膜透析组(APD组),均从置管日即开始渐进式的腹膜透析7d,分别记录其出血压、血肌酐、尿素氮、血钙、血磷、血钾、超滤量、尿量等指标及他们的培训时间、伤口愈合情况;同时随访半年,对比两组患者的腹膜炎发生情况,并分析腹膜炎的相关危险因素.结果治疗前两组患者在主要临床及生化指标方面均无显著差异.过渡治疗一周后IPD组患者血压下降值、电解质下降值、尿量减少情况均较APD组患者显著,差异有显著的统计学意义(P ＜0.05或＜0.01);术后IPD组有7例患者出现伤口渗漏,APD组有1例,两组比较有统计学差异(P =0.032).APD组患者平均每天的学习和培训时间(3.45±1.34h/d)亦显著高于IPD组患者(2.34±0.78h/d),P=0.022.随访半年后两组在主要临床及生化指标方面无显著差异,但随访期间APD组患者腹膜炎发生率(3/44)显著低于IPD组(13/44)(P＜0.05).进一步Logistic回归分析显示年龄是腹膜炎发生的危险因素,培训时间是腹膜炎发生的保护性因素.结论在初置管患者过渡期使用APD方式治疗能够有效清除患者体内毒素,保持患者水电解质平衡,并且增加患者住院期间的透析培训时间,减少远期腹膜炎的发生率,有其明显优越性,值得推广运用.
목적 탐토자동화복막투석재초치관복막투석환자과도기적운용급대환자원기복막염발생솔적영향.방법 장재본복막투석중심진행복막투석치관적환자수궤분위간헐성복막투석조(IPD조)화자동화복막투석조(APD조),균종치관일즉개시점진식적복막투석7d,분별기록기출혈압、혈기항、뇨소담、혈개、혈린、혈갑、초려량、뇨량등지표급타문적배훈시간、상구유합정황;동시수방반년,대비량조환자적복막염발생정황,병분석복막염적상관위험인소.결과 치료전량조환자재주요림상급생화지표방면균무현저차이.과도치료일주후IPD조환자혈압하강치、전해질하강치、뇨량감소정황균교APD조환자현저,차이유현저적통계학의의(P ＜0.05혹＜0.01);술후IPD조유7례환자출현상구삼루,APD조유1례,량조비교유통계학차이(P =0.032).APD조환자평균매천적학습화배훈시간(3.45±1.34h/d)역현저고우IPD조환자(2.34±0.78h/d),P=0.022.수방반년후량조재주요림상급생화지표방면무현저차이,단수방기간APD조환자복막염발생솔(3/44)현저저우IPD조(13/44)(P＜0.05).진일보Logistic회귀분석현시년령시복막염발생적위험인소,배훈시간시복막염발생적보호성인소.결론 재초치관환자과도기사용APD방식치료능구유효청제환자체내독소,보지환자수전해질평형,병차증가환자주원기간적투석배훈시간,감소원기복막염적발생솔,유기명현우월성,치득추엄운용.
Objectives To investigate the application of automated peritoneal dialysis mode on peritoneal dialysis(PD) patients during the transition period and it's influence on peritonitis.Methods Peritoneal dialysis patients after catheter placement in the PD center were randomly assigned into two groups,intermittent peritoneal dialysis mode(IPD group) or automated peritoneal dialysis mode (APD group).All the patients were received graded peritoneal dialysis treatment until the seventh day after catheter placing.The blood pressure (BP),serum creatinine (Scr),serum urea nitrogen (BUN),calcium (Ca),phosphorus (P),potassium (K),ultrafiltration volume and urinary volume of the patients were measured,meanwhile the operative wound and training times of the patients were est imated everyday.All the patients were followed up for six months to compare the incidences of peritonitis and analyze its risk factors.Results Before treatment,the main clinical and biochemical indexes of the patients in the two groups had no significant difference.After transitional therapy of one week,the decline of BP,serum electrolytes,and urine output of the patients in IPD group were higher than those of APD group(P ＜ 0.05 or ＜ 0.01).Wound leakage have occurred in 7 patients in IPD group,but only in 1 patient from APD group.The training time of patients in APD group (3.45 ± 1.34h/d) was also longer than the patients in IPD group (2.34 ± 0.78h/d),P =0.022.After six months follow up,there was no significant difference of the main clinical and biochemical indexes between the two groups.But the incidence of peritonitis in the IPD group (13/44) is higher than APD group (3/44) (P ＜ 0.05).The result of Logistic analysis indicated that age was the risk factor to peritonitis and training time was protection factor to peritonitis.Conclusions APD mode has advantages on removing toxins,keeping the balance of electrolyte and water for PD patients after peritoneal dialysis catheter placement.It could also increase the training time for the patients and decrease the incidence of peritonitis at longterm.It is worthy to be popularized in PD patients.