摘要
目的探讨腹膜超滤失败的危险因素分析及干预策略。方法回顾性分析2017年2月—2019年2月期间在我院进行腹膜透析治疗的116例慢性肾脏病患者的病例资料,通过排查患者的年龄、性别、饮酒史、吸烟史、高血压史、糖尿病史、白蛋白(Alb)、D-二聚体(DD)、纤维蛋白原(Fg)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、总胆固醇(CHOL)、腹膜透析龄、腹膜超滤功能、残肾功能等。根据WHO制定超滤失败定义标准,将超滤失败的患者纳入异常组,超滤成功的患者纳入成功组,采用二元logistic回归分析找出腹膜超滤失败潜在危险因素。结果 116例慢性肾脏病患者在腹膜透析过程中出现超滤失败有46例(异常组),超滤成功70例(成功组)。异常组患者年龄、高血压史、糖尿病史、Fg、腹膜透析时间、腹膜超滤功能、残肾功能与成功组对比,差异有统计学意义(P <0.05);Logistic回归分析发现年龄≥60岁、合并高血压、合并糖尿病、Fg <3.45 g/L、腹膜透析时间≥20个月、腹膜超滤功能下降、残肾功能下降均是慢性肾脏患者行腹膜超滤失败的危险因素,差异有统计学意义(P <0.05)。结论高龄、合并高血压及糖尿病、Fg <3.45 g/L、腹膜透析时间≥20个月、腹膜超滤功能下降、残肾功能下降均是慢性肾脏患者行腹膜透析过程出现超滤失败的危险因素。应加强体能锻炼、活动、基础疾病治疗,在确保透析过程中血液循环,缩短腹透液腹腔留腹时间。
Objective To explore the risk factors and intervention strategies of peritoneal ultrafiltration failure. Method From February 2017 to February 2019, a retrospective analysis was made of 116 cases of chronic kidney disease treated by peritoneal dialysis in our hospital. The age, gender, drinking history, smoking history, hypertension history, diabetes history, albumin(ALB), D-Dimer(D-D), fibrinogen(FG), high-density lipoprotein(HDL), low-density lipoprotein(LDL), total cholesterol(Chol), peritoneal dialysis age, peritoneal ultrafiltration function, residual kidney function and so on were investigated. According to WHO’s definition criteria for failure of ultrafiltration, patients with Abnormal of ultrafiltration were included in failure group, patients with success of ultrafiltration were included in success group, and potential risk factors of failure of peritoneal ultrafiltration were identified by binary logistic regression analysis. Results Ultrafiltration failure occurred in 46 cases(abnormal group) and 70 cases(success group) of 116 patients with chronic kidney disease during peritoneal dialysis. There were significant differences in age, hypertension, diabetes, Fg, peritoneal dialysis time, dialysate intake, peritoneal ultrafiltration function and residual kidney function between the Abnormal group and the successful group(P<0.05). Multivariate logistic regression analysis showed that age ≥ 60 years old, hypertension, diabetes, Fg<3.45 g/L, peritoneal dialysis time ≥ 20 months, peritoneal ultrafiltration function. Decrease in residual renal function and decrease in residual renal function were risk factors for failure of peritoneal ultrafiltration in patients with chronic kidney(P<0.05). Conclusion Old age, hypertension and diabetes mellitus, Fg<3.45 g/L, duration of peritoneal dialysis ≥ 20 months, decline of peritoneal ultrafiltration function and residual renal function are all risk factors for failure of peritoneal dialysis in patients with chronic kidney disease. Physical exercises, activities and treatment of basic diseases should be strengthened to ensure blood circulation during dialysis and shorten the duration of abdominal retention of peritoneal dialysis fluid.
作者
杨微
丁红
YANG Wei;DING Hong(Blood Purification Center,The Fourth Affiliated Hospital of China Medical University,Shenyang Liaoning 110000,China)
出处
《中国继续医学教育》
2020年第21期118-121,共4页
China Continuing Medical Education
基金
辽宁省自然科学基金计划重点项目(名称:醛固酮与腹膜间皮细胞转分化的关系,编号:20170541034)。
关键词
腹膜透析
超滤失败
慢性肾脏病
治疗
危险因素
干预策略
peritoneal dialysis
ultrafiltration failure
chronic kidney disease
treatment
risk factors
intervention strategies
