杨琼琼-腹膜透析导管非感染性并发症及其处理2011-12-15.ppt

* * * * * add 100-150 ml radiocontrast dye to dialysis bag infuse dialysate into patient have patient ambulatory for 30 to 60 minutes to increase intra-abdominal pressure send for CT scan - discuss with the radiologist Leak through Hernia * Leak through Hernia * * 卧床休息和抬高下肢。 暂停腹透，改作血透1-2周左右，大多患者阴囊等外生殖器水肿可消失，并可重新做腹透。 若经上述处理未见好转，可行外科手术修补。 * * don’t use intraperitoneal methylene blue ! * 上述处理后4-6 周可重新PD * 上述处理后4-6 周可重新PD * * * * * * * * * * * * * EPS流行病学 发生率： 0.5% to 2.8% 死亡率：38-63% 发生率和死亡率随PD治疗时间的增加而增加 % Incidence Of EPS Rigby Neph Dial Transplant 1998 Kawanishi Am J Kidney Dis 2004 包裹性腹膜硬化（EPS） 对于反复出现肠梗阻患者，要考虑EPS 对于血性透出液无其他原因解释时，伴有GI症状，要注意是否在EPS炎症期。 预防和治疗？ 激素：可能对早期炎症期有用。 Tamoxifen：抗纤维化治疗？ 手术治疗： Our Center Experience 2006 2007 2008 2009 Catheter insertion 157 192 270 200 Surgical reposition 5 7 9 1 Catheter migration rate 3.2% 3.6% 3.3% 0.5% Fluid Leakage 3 2 2 1 Fluid Leakage rate 1.9% 1.0% 0.7% 0.5% Haemorrhage 2 3 2 1 Haemorrhage rate 1.3% 1.5% 0.7% 0.5% * * * * * 发生率 5%-20%。 * * * （上腹或进入a loculated pocket） * * 可以再入第2袋试试。 * * * * * * * * * * * * Although rates of early (8 weeks) catheter tip migration were similar between the 2 groups, we detected a significant association of the coiled design with increased risk of late (8 weeks) catheter tip migration (P=0.005). The increased risk of overall catheter failure in the coiled group was not statistically significant (P 0.06). In the meta-analysis, coiled catheters were associated significantly with increased risk of catheter tip migration (based on 4 trials: RR, 2.08; 95% CI, 1.30-3.33; P 0.002). * coiled catheters may be more prone to migration and resultant dysfunction. * * * * * Adv Perit Dial JT 2000 16 45 The role of catheter configuration in preventing migration (前瞻性 RCT ) 对等比较（均为double-cuff，末端卷曲管） Swan neck coiled Vs Coiled Tenckhoff Swan neck 明显减少导管移位等机械相关并发症 1％ 2 (243) Swan neck 15％ 33 (219) Tenckoff 比 例 移 位 组 别 Conclusion: double-cuff, curled-end Swan-neck are superior