腹膜透析处方调整完整版.pptVIP

Hong Kong Study No significant difference in short term patient survival from total Kt/V 1.5 or above More clinical problems and anemia with Kt/V1.7 No significant difference in outcome between 1.7-2.0 and 2.0 Conclusion Minimal Kt/V should be 1.7 Kidney Int 2003;64:649 总溶质清除率目标值 Kt/V1.7，则为透析充分 腹膜平衡试验（PET） 开始透析后一个月进行一次腹膜平衡试验 之后每6个月一次 腹膜平衡试验（PET） 目的：明确腹膜转运类型，帮助透析剂量调整 标准方案： 前夜标准方案 直立引流前夜存液，超过20分钟 仰卧，2L 2.5%Dextrose灌入，每400ml身体翻转 记录注入时间，为0小时 0小时、2小时放出200ml至废液袋 混匀，取样10ml 2小时取血样测肌酐及糖浓度 腹膜平衡试验（PET） 4小时直立引流20分钟，测量记录引流量 混匀，透析液取样10ml 送检3份透析液样本及一份血样，检测肌酐及糖浓度 结果分析 腹膜平衡试验（PET） 腹膜平衡试验（PET） 腹膜转运类型及特点 类型 比率 肌酐D/P4小时 特点 高转运 10％ 0.82-1.03 溶质及糖转运迅速超滤问题 高平均转运 53％ 0.65-0.81 溶质转运较好 超滤较好 低平均转运 31% 0.50-0.64 溶质转运较差 超滤较好 低转运 6％ 0.34-0.49 溶质转运差 超滤很好 根据腹膜转运类型选择透析方式 类型 推荐的方式 高转运 APD 高平均 CAPD(2.0× 4) 低平均 CAPD(2.0× 4);或增加灌入量 低转运 增加灌入量或改血透 临床表现 恶心、呕吐、失眠、不安腿等毒素蓄积症状； 高血压、心衰、浮肿等水分蓄积症状 营养状况良好 酸碱、电解质平衡 钙磷代谢平衡 贫血是否纠正 临床表现 有一定的相关性，不完全一致的情况 不能作为评估透析充分性的早期指标： 潜隐性，一旦出现已为不可逆性或致死性 CAPD患者依从性 每日总的肌酐排除量或呈现率可以反应病人依从性 成人如果尿和透析液中每日肌酐的排除量和基础值相差大于15％ CAPD患者依从性 留腹时间不当 未随残余肾功能丢失增加透析剂量 留腹容量不当 日间交换留腹时间短，夜间留腹时间过长 透析液浓度选择问题 Acute schedule. PD solution is instilled and drained every 30 minutes to 2 hours. The usual treatment length is 48-72 hours. APD has become a daily home treatment with automated nightly exchanges and the possibility for additional one or two daily dwells(CCPD). In the USA today, APD is utilized by 31.9% of all PD patients, including daytime dwell mode, daytime empty mode and schedules with one or more additional hand exchanges. Standard CAPD and APD have lost market share in recent year.This id due to the perception that these techniques fail to provide adequate small solute clearance.Large patients tend to become underdilyzed as their residual renal function declines over time. CFPD was developed as a techinque in which a certain amount of fluid was constantly present in the abdoment and inflow and outflow were maintained constant without interrupti