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目的探讨腹膜转运功能对自动腹膜透析(APD)充分性的影响。方法选择2009年1月至12月在北京大学人民医院肾内科住院的腹膜透析患者14例,先后行CAPD和APD治疗,并进行PET试验测定腹膜溶质转运功能。分别比较不同腹膜功能患者APD与CAPD充分性差异的异同。并比较不同腹膜功能患者延长存腹时间对APD充分性的影响。结果 APD小分子溶质清除充分性指标——尿素清除指数(KT/V)1.77±0.57,内生肌酐清除率(Ccr/w)(46.6±19.9)L——可达标,超滤量与CAPD无差异。虽APD总Ccr/w(46.6±19.9)KT/V较CAPD(63.8±29.4)KT/V下降,但亚组分析显示,此差异主要来自低转运、低平均转运者。这部分患者APD 14 h KT/V(1.67±0.50)较10 h(1.45±0.48)增加。结论 APD尤其适用于腹膜高转运、高平均转运患者;低转运、低平均转运者小分子溶质清除充分性差,需延长存腹时间或增加透析剂量。
Objective To investigate the effect of peritoneal transport on the adequacy of automatic peritoneal dialysis (APD). Methods From January 2009 to December 2009, 14 patients undergoing peritoneal dialysis were enrolled in Department of Nephrology, Peking University People’s Hospital. Patients underwent CAPD and APD followed by PET to determine peritoneal solute transport. The differences between APD and CAPD in patients with different peritoneal function were compared. The effects of prolonged CPF on the adequacy of APD in patients with different peritoneal functions were compared. Results The adequacy index of APD small molecule solute removal - KT / V 1.77 ± 0.57, Ccr / w (46.6 ± 19.9) L - up to standard, ultrafiltration volume and CAPD difference. Although APD total Ccr / w (46.6 ± 19.9) KT / V was lower than CAPD (63.8 ± 29.4) KT / V, subgroup analysis showed that the difference mainly came from low-transport and low-average transporters. The APD 14 h KT / V (1.67 ± 0.50) in this part of patients increased more than 10 h (1.45 ± 0.48). Conclusions APD is especially suitable for patients with high peritoneal transport and high average transfusion. Low-transport and low-average transfusion of small molecule solute clearance is poor, need to extend the time to save the stomach or increase the dialysis dose.