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长期腹膜透析方式的选择

Author
John M Burkart, MD
Section Editor
Steve J Schwab, MD
Deputy Editor
Alice M Sheridan, MD
Translators
郑可, 主治医师

引言

腹膜透析(peritoneal dialysis, PD)有几种的不同技术可用。在讨论这些方式之前，简要回顾腹膜透析溶质清除率的决定因素很有帮助。腹膜透析时，腹膜血流速和透析液流速要远远低于血液透析时两者的流速(血液透析时，两者常常高于400mL/min)。因此，相比于血液透析，腹膜透析时每单位时间尿素和其他小分子溶质的清除率远远更低。然而，腹膜透析通常以一种持续的方式进行，所以每周的溶质清除率接近血液透析的清除率。

了解尿素会快速弥散进入到腹膜透析液(最初不含尿素)也很重要，因此，透析液与血浆尿素的浓度比平均值在2小时为0.70，且在4小时为0.90。肌酸酐的透析液与血液浓度比在2小时为0.40，在4小时为0.55(图 1)。因此，在腹膜透析液留腹的最初几小时内，尿素和其他小分子溶质被快速清除；4小时后，由于浓度接近平衡，仅有很少部分小分子溶质被进一步清除。然而，那些未迅速达到平衡的较大分子溶质仍持续被清除。

腹膜透析的类型

腹膜透析可以以持续或间断的方式进行[1]。持续不卧床腹膜透析(continuous ambulatory peritoneal dialysis, CAPD)包含日间多次交换(通常3次)，随后进行整夜留腹。改良模式包括应用1个交换装置进行1次夜间交换，从而可实现2次夜间交换和3次日间交换[2]。曾有设计特别用以此目的的装置(夜间交换装置)；然而，这种装置现在已不再可用。因此，这种改良的CAPD目前很少应用；当应用这种改良方式时，需要标准的循环控制装置。

自动化腹膜透析(automated peritoneal dialysis, APD)应用了一种循环控制装置，可进行多次夜间交换。此技术的改良包括持续循环性腹膜透析(continuous cycler peritoneal dialysis, CCPD)、夜间间歇性腹膜透析(nightly intermittent peritoneal dialysis, NIPD)以及潮式腹膜透析(tidal peritoneal dialysis, TPD)[3]：

●CCPD有较长时间的日间留腹和几次夜间循环。进行CCPD的少数患者不进行日间腹透液留腹，部分患者也必须进行1次中午腹透液交换，以达到透析充分或超滤(ultrafiltration, UF)目标[2]。

           

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Literature review current through: 2017-06 . | This topic last updated: 2016-09-01.
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