中国血液净化

中国血液净化 ›› 2022, Vol. 21 ›› Issue (10): 734-738.doi: 10.3969/j.issn.1671-4091.2022.10.007

• 临床研究 • 上一篇    下一篇

腹膜透析患者腹腔内压力的临床研究

尚 玉   刘思远   杨笑筠    李 岩    纪天蓉    孔凡武   

  1. 150000 哈尔滨，1哈尔滨医科大学附属第二医院肾内科
  • 收稿日期:2022-03-16 修回日期:2022-07-28 出版日期:2022-10-12 发布日期:2022-10-12
  • 通讯作者: 孔凡武 E-mail:kidney1979@163.com
  • 基金资助:
    中国博士后科学基金(2017M610213)；黑龙江省博士后科学基金(LBH-Z18128)

Clinical study of intra-abdominal pressure in patients with peritoneal dialysis 

SHANG Yu,  LIU  Si-yuan, YANG Xiao-jun, LI Yan, JI Tian-rong, KONG Fan-wu   

  1. Department of Nephrology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150000, China
  • Received:2022-03-16 Revised:2022-07-28 Online:2022-10-12 Published:2022-10-12
  • Contact: 150000 哈尔滨，1哈尔滨医科大学附属第二医院肾内科 E-mail:kidney1979@163.com

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摘要： 目的 验证与腹膜透析(Peritoneal dialysis,PD)患者腹腔内压力(intra-abdominal pressure,IAP)变异性相关的机体相关因素，并探究IAP对PD治疗的影响。 方法 本研究以新进入PD治疗的35例患者作为研究队列。采用Durand法分别于手术后第3天及PD维持治疗6个月后稳定期，透析剂量(peritoneal dialysis volume,PDV)为2000ml时，分别测定患者的IAP。根据稳定期测定IAP均值(12.27±2.37)cmH2O，将受试者分为IAP＜12.27cmH2O组(以下简称Ⅰ组)与IAP≥12.27cmH2O组(以下简称Ⅱ组)。 结果  ①手术后3天的测定IAP明显高于稳定期IAP(t=14.766，P＜0.001)；②Ⅰ组患者在体质量、体质量指数(body mass index,BMI)、体表面积(body surface area,BSA)低于Ⅱ组(t值分别为    -2.990、-3.838、-2.277，P值分别为0.005、0.001、0.029)，总Kt/V、总肌酐清除率(creatinine clearance,Ccr)、残余肾Kt/V、残余肾Ccr方面高于Ⅱ组(t值分别为2.582，-2.450，2.875，-2.583；P值分别为0.014，0.014，0.007，0.009)；③相关性分析显示BMI与手术后第3天(r=0.558，P＜0.001)及PD维持治疗6个月后(r=0.688，P＜0.001)测定的IAP均呈正相关，进一步进行线性回归分析得到直线方程：手术后3天IAP=0.425×BMI＋4.975，r2=0.311，P＜0.001；稳定期IAP=0.548×BMI-0.245，r2=0.473，P＜0.001； ④透析充分组的IAP明显低于透析未达标组(t=-2.156，P=0.038)。结论  ①PD患者维持治疗6月后的IAP较手术后3天明显降低；②IAP变异性与机体个体特征相关，其中BMI是与IAP关联性更好的人体测量变量；③IAP与PD患者残余肾功能的保留密切相关，维持一定范围内相对较低的IAP在PD治疗的早期具有更高的透析效能。

关键词: 腹腔压力, 体表面积, 体质量指数, 透析充分性

Abstract: Objective  To investigate the factors relating to the variation of intra-abdominal pressure (IAP) in patients undergoing peritoneal dialysis (PD) and to explore the effect of IAP on PD therapy.  Methods  A total of 35 patients newly treated with PD were used as a study cohort. The Durand method was used to determine IAP. IAP was measured at the 3rd day after the surgery and after 6 months at a stable PD stage. The dialysate volume (PDV) was 2000mL when IAP was measured. Based on the mean IAP of 12.27±2.37 cmH2O at the stable PD stage, the patients were divided into group I (IAP ＜12.27cmH2O) and group II (IAP≥12.27cmH2O).  Results   ①The IAP at the 3rd day after the surgery was significantly higher than that at the stable stage (t=14.766, P＜0.001);  ②Body weight (t=-2.990, P=0.005), body mass index (BMI) (t= -3.838, P=0.001), and body surface area (BSA) (t=-2.277, P=0.029) were lower in group I than in group II, while total Kt/V (t=2.582, P=0.014), total Ccr (t=-2.450, P=0.014), residual kidney Kt/V (t=2.875, P=0.007), residual kidney Ccr (t=-2.583, P=0.009), and dialysis adequacy rate (P=0.044) were higher in group I than in group II.  ③Correlation analysis showed that BMI was positively correlated with the IAP after the surgery for 3 days  (r=0.558, P＜0.001) and after the operation for 6 months (r=0.688, P＜0.001). Linear regression obtained two equations: the IAP after the surgery for 3 days=0.425×BMI＋4.975 (r2=0.311, P＜0.001), and the IAP after the operation for 6 months=0.548×BMI-0.245 (r2=0.473, P＜0.001). ④ The IAP was significantly lower in the patients with adequate PD than in those with inadequate PD patients (t=-2.156, P=0.038).   Conclusion   ①IAP is significantly lower in the PD patients after the surgery for 6 months at a stable PD stage than in those after the surgery for 3 days. ②IAP variability is related to the characteristics of the patients, in which BMI is a factor closely related to the level of IAP. ③IAP is also closely related to the residual renal function of the patient. Maintaining IAP at a relatively low level will facilitate a higher dialysis efficacy at the early stages of PD.

Key words:  Intra-abdominal pressure, Body surface area, Body mass index, Dialysis adequacy

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