CAPD术后两种即时透析方式的疗效观察

目的探讨CAPD术后即时透析的最佳方式。方法选择行首次腹透植管术的慢性肾衰竭尿毒症患者146例，于CAPD术后随机分为强化透析组70例和减半透析组76例，强化透析组术后第1～3d行1000ml腹透，每日10次；减半透析组第1～3d每日1000ml腹膜透析6次。分别观察两组患者CAPD术后即时透析疗效及并发症情况，并进行比较。结果两组病人透析前后血BUN、Cr、Hb、Alb、电解质等比较无差异（P〉0．05）；但2周内并发症比较差异有显著性（P〈0．05），强化透析组共发生不良反应36例次，发生低血钾和低血压分别为19和8例次；减半透析组共发生不良反应14例次，仍以低血钾、低血压常见。所有的不良反应均经对症支持治疗后好转，未停止腹透，术后2周内均未发生腹膜感染。结论CAPD术后即时行腹膜透析切实可行，减半透析方式优于强化透析方式。

Efficacy of two dialysis modalities immediate after CAPD catheter insertion

Objective To investigate the efficacy of different dialysis modalities immediate after CAPD catheter insertion by comparing effectiveness and short-term complications. Methods 146 chronic uremic patients who received the first CAPD catheter insertion in our hospital from January 2004 to December 2005 were enrolled in this study. The average age was 43±13 years （20-74 years） including 89 male and 57 female patients. Patients after CAPD insertion were randomized assigned to the intensive dialysis group （70 patients with an average age 44±11 years ） and the controlled group （76 patients with an average age 43±14 years ）. From the first day after CAPD insertion to the third day, patients in intensive dialysis group underwent peritoneal dialysis with 1000ml/exchange, 10 exchanges/day, while in the controlled group patients underwent peritoneal dialysis with 1000ml/exchange, 6 exchanges/day. Complications and wound healings of each group were recorded in the next two weeks. Results There were no significant differences in age, sex and blood level of urea creatinine,homeglobin, albumin, electrolytes between two groups before and after CAPD insertion, In intensive group, 36 patients experienced adverse effects, 19 patients （41%） developed hypokalemia and 8（11%） patients had hypotension. Only 14 （18%） patients in controlled group developed adverse effects, less than patients in intensive group （P〈0. 05）. Conclusions It is feasible to perform peritoneal dialysis immediate after CAPD insertion. Initiating peritoneal dialysis with fewer doses had significant advantage over intensive dialysis.