住院腹膜透析患者管理2025.docxVIP

住院腹膜透析患者管理2025

对于处于终末期肾病的患者，透析治疗是主要的肾脏替代治疗手段，包括腹膜透析(PD)与血液透析(HD)。当患者需紧急启动腹膜透析，或已规律行腹膜透析的患者因腹膜透析相关并发症及其他合并症住院时，则需开展住院腹膜透析治疗。腹膜透析患者住院期间，感染性并发症和非感染性并发症的发生风险较高。临床需建立规范化的诊疗与护理体系，通过密切监测病情、严格无菌操作、及时干预并发症等措施，可有效降低不良事件影响，对帮助患者维持原有腹膜透析方式、减少治疗方案被迫转换具有重要意义。近期，《CJASN》杂志发表一项综述，提出了住院腹膜透析患者的系统化管理路径建议(图1)。内容涵盖患者专用透析设备的相关介绍、自动化腹膜透析(APD)与持续不卧床腹膜透析(CAPD)的对比分析、急诊科对腹膜透析患者的接诊处置规范、腹膜透析患者住院期间的常见问题及应对，以及住院期间影像学检查的应用要点与患者长期治疗规划的制

定策略。

PreparingforHospitalPeritonealDialysis

Step0

HomeEMS

图中、

Instructionstopatient

1.Bringtreatmentandmedicationdocumentation

2.BringmostrecentPDfuidemuent

3.TakeoralantibioticsasinstructedbyoutpatientPDcenterPhysician/dialysisunit

·ConsicerdirectadmissionbypassingER,calltheERtoconweytransterofcareInstructionstoEmergencyMedicalSystem(EMS)

·BringPDffluentanddialysissuppliestoratleast1exchange;considerperitonitsforabdominalpain

Step1

Emergencyroom

·Ensuresupploscompatiblowithpatienscathetoravailable

·CreaseanordersetforPDeffuentensure120minofdwellimebeforesampling

·Expedibeantbioics.,butconsiderdiagnosesotherthanpenibonitisinunstablepatients

·LowthresholdforKUBtoassssstooiburdenandcathetertipposition

Step2

Hospitalwards

Infectionprevention

·EstablishroomswhorePDcanbedonesaberly

Nursing

·EstabishedteamofnursestoperlormPDandmanagecomplicationswithprotocolsconstipation,catheterflushing,andtransfersetexchange.DaytimecyclerinitiationDailycare

·Carefulvolumeassessment,dietaryadjustment,anddialysatedextroseadjustmentPharmacy

·CreatealistofempiricIPantibiotics;standardizedosesforantibiotics,intraperitonealheparin.andintra-catheterateplase

Step3

Hospitalradiology

·Trainpersonneltoperformperitoneograprysalelywithintraperitonealcontrastornucearmedicinetracer

·Followstandardofcaretoavoidcontrastinducednephropathy

NephrologistsshouldcommunicatewithradiologytorecognizeEPS,eval