【摘要】 目的 探讨生理钙透析液对持续性不卧床腹膜透析（CAPD）患者钙磷代谢的影响。 方法 回顾性分析2008年1月-2009年12月腹膜透析患者的钙磷指标，资料齐全的患者中使用钙浓度为1.25 mmol/L的腹膜透析液（生理钙组）的患者有30例，使用钙浓度为1.75 mmol/L的透析液（标准钙组）患者30例。对两组患者钙磷代谢指标进行比较。 结果 治疗前后两组的血磷、钙磷乘积和全段甲状旁腺素差异均无统计学意义（Pgt;0.05）；治疗后标准钙组血钙较前升高，差异有统计学意义（Plt;0.05），而生理钙组治疗前后血钙差异无统计学意义（Pgt;0.05）。 结论 不同含钙浓度腹膜透析液对机体钙磷代谢的影响是不同的，在高钙、高磷、低转运骨病的腹膜透析患者中使用钙浓度为1.25 mmol/L的生理钙透析液减轻了钙负荷，为临床医生使用含钙磷结合剂提供了治疗空间。【Abstract】 Objective To investigate the effects of physiological calcium dialysate on the calcium and phosphorus metabolism in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Methods We retrospectively analyzed the clinical data of 60 patients having undergone CAPD in West China Hospital of Sichuan University between January 2008 and December 2009. The patients were divided into two groups with 30 in each by calcium concentration of the dialysate: the physiological calcium dialysate group (1.25 mmol/L) and the standard calcium dialysate group (1.75 mmol/L). The metabolism indexes of calcium and phosphorus for the two group of patients were compared. Results Levels of Serum phosphate, calcium-phosphate product and immoreactive parathyroid hormone (iPTH) of all the patients in both groups before and after treatment showed no significant differences (Pgt;0.05). Serum calcium increased significantly in patients treated with standard calcium dialysate (Plt;0.05), while it did not change significantly in patients treated with physiological calcium dialysate (Pgt;0.05). Conclusions Dialysate with different concentrations of calcium provides different influence on the metabolism of calcium and phosphorus. Changing calcium concentration to 1.25 mmol/L in the dialysate can lower the calcium load for patients with hypercalcium and/or hyperphosphate with low bone turnover, providing treatment space for clinical doctors to use binders containing both calcium and phosphorus.
ObjectiveTo investigate whether continuous quality improvement (CQI) measures can reduce the episodes of peritonitis. MethodsWe analyzed the data of 114 cases of peritoneal dialysis related peritonitis from January to December 2011 before applying CQI measures and 72 cases from January and December 2012 after applying CQI measures in West China Hospital. Then we studied the episodes, cause and pathogenic bacteria species of peritonitis in peritoneal dialysis patients. We implemented the process of reducing the episodes of peritonitis by applying PDCA four-step design: plan-do-check-act. ResultsThe episodes of peritonitis were reduced from per 60.8 patient-months (0.197/patient-years) to per 66.6 patient-months (0.180/patient-years) after applying CQI measures. The positive rate of pathogenic bacteria culture was both 50.0% before and after applying CQI measures, in which 66.7% were gram-positive cocci. The curing rate of peritonitis was increased from 57 case/times (76.3%) to 87 case/times (79.2%). Switching to hemodialysis rate was reduced from 17 cases/times (14.9%) to 10 cases/times (13.9%). Death cases was reduced from 9 cases/times (7.9%) to 5 cases/times (6.9%). ConclusionThese results show that the incidence of peritoneal dialysis related peritonitis decreases and the curing rate increases through CQI measures.
During the medical rescue after Wenchuan earthquake, based on the design and implementation of the management process of blood purification equipment, we gave the top priority to those patients with post-disaster crush syndrome to ensure their hemodialytic treatment. Through strict management of blood purification technology, the outcomes of these patients have been fundamentally improved and the incidence of complications was substantially reduced. Safe and effective hemodialytic treatment have been administered to 77 patients with crush syndrome (813 case-times).
目的 分析持续腹膜透析患者发生腹膜炎的情况及相关因素，降低腹膜透析患者腹膜炎发生率、退出率，提高患者的生存率、生活质量。 方法 回顾分析2011年1月－6月收治的41例在家中行持续非卧床性腹膜透析且发生腹膜炎患者的临床资料，观察腹膜炎的发生率及转归，腹膜炎症状出现后初始的处理，对腹膜炎的诱因进行分析。 结果 41例腹膜透析患者共发生腹膜炎43例次，痊愈35例（85.4%），转血液透析3例（7.3%），死亡3例（7.3%）。在症状出现初期，3例（7.3%）患者继续在家观察，10例（24.4%）患者立即到当地就医，15例（36.6%）患者采用电话咨询，13例（31.7%）患者到腹膜透析中心就诊；18例（43.9%）患者直接将腹膜透析引流液带到医院进行药敏试验。就感染诱因而言，16例（39.0%）患者未严格进行空气消毒，13例（31.7%）患者未严格进行环境清洁，10例（24.4%）患者操作过程存在污染行为。 结论 加强对居家行腹膜透析患者的初次培训、操作指导及监测，可避免腹膜炎的发生，提高患者生活质量。
目的 比较两种不同方法护理腹膜透析患者导管出口处的效果。 方法 选取2008年7月－2009年12月51例患者作为试验组，直接采用聚维酮碘溶液擦洗导管出口处，2007年1月－2008年7月45例患者作为对照组，先用生理盐水清洗遂道口，再用聚维酮碘溶液擦洗导管出口处。比较两组导管出口处感染的情况及操作所需时间。 结果 试验组出口评分系统（ESS）＜2分15例，2～3分34例，≥4分7例；对照组＜2分10例，2～3分24例，≥4分16例；两组差异有统计学意义（P＜0.05）。试验组护士操作时间为（3.0 ± 1.0）min，患者操作时间为（5.0 ± 1.5）min；对照组护士操作时间为（8.0 ± 2.0）min，患者操作时间为（10.0 ± 2.0）min；两组差异有统计学意义（P＜0.05）。 结论 聚维酮碘溶液直接清洗、消毒导管出口处降低了感染的发生率，减少了操作环节和所需物品，缩短了操作时间。
【摘要】 目的 探索持续非卧床腹膜透析（CAPD）患者年龄与营养状况的关系，为营养教育提供指导。 方法 对2007年8月-2010年1月腹膜透析177例患者的临床资料进行回顾性分析，包括血红蛋白（HGB）、血清白蛋白（ALB）、年龄、体重指数（BMI）、腹膜平衡试验（PET）、尿素清除指数（Kt/V）、24 h尿蛋白、腹透液漏出蛋白、标准化每日蛋白质分解率（nPCR）等，分析年龄与营养状况的关系。 结果 老年组（≥60岁）和中青年组（lt;60岁）ALB分别为（31.54±5.91）、（33.24±4.75）g/L，老年组ALB较低（Plt;0.05）；老年组Kt/V值1.95±0.63和HGB水平（95.25±22.89） g/L均高于青年组（Plt;0.05）。两组患者营养不良与BMI、PET、每日蛋白漏出总量、nPCR无关。 结论 CAPD老年患者（≥60岁）更容易发生营养不良，且老年组低蛋白血症与透析充分性无明显关系。故应加强老年CAPD患者的饮食营养管理指导，设计合理的饮食。【Abstract】 Objective To investigate the relationship between age and nutrition status of the patients undergoing continuous ambulatory peritoneal dialysis (CAPD), and provide instructions for nutrition education. Methods We retrospectively analyzed the clinical data of 177 patients having undergone CAPD in the Department of Nephrology of West China Hospital between April 2007 and January 2010. Clinical parameters collected included hemoglobin (HGB), serum albumin (ALB), age, body mass index (BMI), results of the peritoneal equilibrium test (PET), urea clearance index (Kt/V), 24-hour urinary protein, protein loss in the peritoneal dialysate, normalized protein catabolic rate (nPCR). Relationship between age and nutrition status in these patients were analyzed. Results Plasma albumin was (31.54±5.91) g/L and (33.24±4.75) g/L respectively in patients of or older than 60 years old (the elderly group) and in patients younger than 60 years old (the younger group). Compared with the younger group, patients in the elderly group had lower ALB (Plt;0.05), but higher Kt/V 1.95±0.63 and hemoglobin level (95.25±22.89) g/L (Plt;0.05). In addition, malnutrition in both groups was not associated with BMI, PET results, daily protein loss in the peritoneal dialysate or nPCR. Conclusions Patients of or older than 60 years old undergoing CAPD are more likely to develop malnutrition, indicating that hypoalbuminemia is not associated with dialysis inadequacy. We advocate enhancing diet nutrition education in elderly CAPD patients and providing them with balanced diet regime.