中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (05): 387-391.doi: 10.3969/j.issn.1671-4091.2025.05.006

• 临床研究 • 上一篇    

腹膜透析引流后腹腔残留液体量影响因素及其对透析效能的影响

程学宾    李 岩    杨笑筠    纪天蓉    孔凡武   

  1. 150086 哈尔滨，1哈尔滨医科大学附属第二医院肾内科
  • 收稿日期:2024-07-01 修回日期:2025-03-02 出版日期:2025-05-12 发布日期:2025-05-12
  • 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)

Factors affecting peritoneal residual volume after peritoneal dialysis drainage and its impact on dialysis efficiency

CHENG Xue-bin, LI Yan, YANG Xiao-yun, JI Tian-rong, KONG Fan-wu   

  1. Department of Nephrology, Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
  • Received:2024-07-01 Revised:2025-03-02 Online:2025-05-12 Published:2025-05-12
  • Contact: 150086 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

摘要： 目的 探讨腹腔残余液体量(peritoneal residual volume,PRV)影响因素及其对透析效能的影响。 方法  收集2019年1月─2023年12月哈尔滨医科大学附属第二医院腹膜透析中心接受维持性腹膜透析治疗患者的人口学、临床生化学等资料，通过腹部卧位平片或盆腔CT记录腹膜透析导管尖端位置；检测4小时及0小时腹膜透析液肌酐值，通过Twardowski方法计算腹膜透析后PRV。根据PRV水平分为高PRV组和低PRV组，采用t检验单因素及多因素分析PRV的影响因素，探讨PRV对透析效能的影响。  结果 本研究共纳入112例研究对象，其中彩超引导下经皮穿刺置管手术72例(64.3%)，外科手术法置管40例(35.7%)，2种术式的导管尖端位置间比较无统计学意义(r=0.665，P=0.717)。PRV与导管尖端位置有关(t=-8.502，P=0.001)，与腹部手术史(t=1.372，P=0.173)、BMI(t=-0.534，P=0.594)、腹围(t=0.580，P=0.563)、手术方式(t=-0.290，P=0.773)之间无统计学意义。与高PRV组(n=39)比较，低PRV组(n=73)患者腹膜透析后血压控制较好(t=-5.019，P=0.001)，NT-proBNP较低(t=-3.537，P=0.001)，透析Kt/V较高(t=4.430，P=0.001)，透析Ccr较高(t=2.786，P=0.001)，前白蛋白较高(t=2.057，P=0.031)。 结论  腹膜透析导管尖端在腹腔的位置影响PRV；高PRV影响腹膜透析效率。

关键词: 腹腔残余液体量, 腹膜透析效能, 影响因素

Abstract: Objective  To investigate the factors influencing peritoneal residual volume (PRV) and its impact on dialysis efficiency in patients undergoing peritoneal dialysis.  Methods Data on demographics and clinical biochemistry were collected from patients receiving maintenance peritoneal dialysis between January 2019 and December 2023 at the Second Affiliated Hospital of Harbin Medical University. The position of the peritoneal dialysis catheter tip was recorded via abdominal supine radiography or pelvic CT. PRV after dialysis was calculated using the Twardowski method based on creatinine levels in the dialysate at 0 and 4 hours. Patients were divided into high-PRV and low-PRV groups, and factors influencing PRV were analyzed using t-tests. The impact of PRV on dialysis efficiency was also assessed. Results  A total of 112 patients were included, with 72(64.3%) undergoing ultrasound-guided percutaneous catheter placement and 40(35.7%) undergoing surgical placement. There was no significant difference in catheter tip position between the two methods (r =0.665, P =0.717). PRV was associated with catheter tip position (t=-8.502,P=0.001) but not with abdominal surgery history, BMI, abdominal circumference, or surgical method. Compared to the high-PRV group (n =39), the low-PRV group (n =73) had better post-dialysis blood pressure control (t =-5.019, P=0.001), lower NT-proBNP (t=-3.537, P=0.001), and higher dialysis Kt/V (t = 4.430, P=0.001), Ccr (t =2.786, P=0.001), and prealbumin levels (t=2.057, P=0.031).  Conclusions The position of the peritoneal dialysis catheter tip in the abdomen affects PRV, and high PRV reduces peritoneal dialysis efficiency.

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