日间不卧床腹膜透析与持续非卧床腹膜透析对心血管并发症的影响

肾脏病与透析肾移植杂志 ›› 2013, Vol. 22 ›› Issue (5): 427-433.

日间不卧床腹膜透析与持续非卧床腹膜透析对心血管并发症的影响

出版日期:2013-10-28 发布日期:2013-10-28

Affects of daytime and continuous ambulatory peritoneal dialysis on cardiovascular complications in patients with ESRD

Online:2013-10-28 Published:2013-10-28

摘要/Abstract

摘要：

摘要：
目的：比较日间不卧床腹膜透析(DAPD)与持续不卧床腹膜透析(CAPD)对心血管合并症的影响。
方法：2010年6月至2010年12月期间在我院行PD置管术的患者，随机分成两组，每组32例，一组采用CAPD模式，即每日透析剂量为6-8L、夜间留腹；另一组采用DAPD模式，即每日透析剂量为6-8L、夜间干腹。观察两组患者充血性心力衰竭、恶性高血压等心血管并发症的发生率、发生时间及转归，每半年进行一次容量及心功能的评估，行心脏超声和胸部平片检查，动态观察透析前、6个月、12个月心胸比例，左心室内径、左心房内径、左心室壁厚度、右心室内径、室间隔厚度等心血管系统相关指标的变化情况，同时观察血压、透析效能、残余肾小球滤过率的变化情况。结果：（1）本研究共入组64例PD患者，CAPD组患者1、2年心血管事件发生率为16%、28%，而DAPD组分别为6%，13%（P<0.05），随着透析时间的延长，其发生率增加。（2）两组患者入组时心胸比例无统计学差异，随访至24月两组患者心胸比例分别为0.51±0.04，0.48±0.05，CAPD组患者心胸比例明显大于DAPD组（P<0.05）。同时两组左心室内径分别为52.66±6.49mm，48.69±4.70mm，有统计学差异（P<0.05）。（3）在末次随访中，以血压<140/90mmHg为标准，CAPD、DAPD组的血压达标率分别为54.2%、84.8%，CAPD组患者的血压达标率明显低于DAPD组患者（P<0.05）。（4）在透析效能方面，两组溶质清除均充分，且无明显差异。结论： DAPD透析模式心功能不全发生率低，心胸比例变化小，较CAPD模式对心血管系统影响小，可能与容量负荷、残余肾功能状态有关。

Abstract:

Objective: To investigate the cardiovascular complications in daytime ambulatory peritoneal dialysis (DAPD) and continuous ambulatory peritoneal dialysis (CAPD). Methodology: In this prospective study, sixty four patients which received peritoneal dialysis (PD) from June 2010 to December 2010 were enrolled and randomized into group CAPD and group DAPD. The patients with CAPD were treated by using the dialysate 6-8L/day, and peritoneal dialysate left in abdomen cavity at night and the patients with DAPD were treated by using the dialysate 6-8L at daytime, and evacuated of dialysate from abdomen at night. The parameters of incidence rate, time and prognosis of congestive heart failure, malignant hypertension and some other cardiovascular complication were observed between two groups. The cardiac function and construct including the dynamic changes of cardiothoracic ratio, left ventricular internal diameter, left atrial diameter, left ventricular wall thickness, right ventricular diameter, and interventricular septal thickness,were detected by echocardiography and chest radiograph every 6 month in all patients. Meanwhile, the blood pressure, dialysis adequacy and residual glomerular filtration rate were also investigated. Results: (1) 1, 2-year of the chronic heart failure (CHF) incidence was 16%, 28% in group CAPD, and 6%, 13% in group DAPD respectively (P<0.05). With the extending of time on PD treatment, the CHF incidence was gradually increasing. (2)The CTR had no difference between two groups at baseline, but at the end of follow-up the CTR of group CAPD and DAPD were 0.51±0.04, 0.48±0.05 respectively (P<0.05). The left ventricular internal diameter of group CAPD and DAPD were 52.66±6.49, 48.69±4.70mm respectively, and there was a significant difference (P <0.05). (3)At the end of follow-up, blood pressure <140/90mmHg as a standards, the compliance rate of BP was 54.2%, 84.8% in group CAPD and DAPD（P<0.05）, the rate of group CAPD was significantly lower than that of group DAPD. (4)Dialysis adequacy had no difference in two groups. Conclusion: The incidence of cardiovascular complication was lower in DAPD patients, and the change of cardiothoracic ratio was little, which might relate to volume status and residual renal function.

王涵,周岩,李韬彧,等. 日间不卧床腹膜透析与持续非卧床腹膜透析对心血管并发症的影响[J]. 肾脏病与透析肾移植杂志, 2013, 22(5): 427-433.

WANG Han, ZHOU Yan, LI Tao-yu,et al. Affects of daytime and continuous ambulatory peritoneal dialysis on cardiovascular complications in patients with ESRD[J]. Chinese Journal of Nephrology, Dialysis & Transplantation, 2013, 22(5): 427-433.

ISSN 1006-298X CN 32-1425/R