腹膜透析基础课件.pptVIP

腹膜透析基础CommoncomplicationsinPD

腹透并发症PeritonitisExitsiteinfectionFluidoverload腹膜炎出口感染容量过多腹膜透析基础TheimpactofPeritonitisonCAPDResults

腹膜炎对CAPD影响CausesCatheterlossin8.2%ofcasesCatheterinfectionin10.8%ofcasesAccountsfor24.2%ofhospitalizationcases6.7%ofdeath30.0%ofdrop-outViglioetal.Adv.PeritDial1992.8:269-275原因导管故障8.2%导管感染10.8%导致住院率24.2%死亡率6.7%患者退出腹透30.0%腹膜透析基础PETcalculationPET：计算Thecorrectionfactorforcreatininebyhighglucoseindialysissolutionsisbestdeterminedbyindividuallab.ThecorrectionfactorusedbytheUniversityofMissouri–0.000531415.Correctedcreatininemg/dl=creatininemg/dl–(glucoseX0.000531415)mg/dl由于透析液中高浓度葡萄糖影响，肌酐测定需要的校正因子最好由每个实验室确定.密苏里大学使用的校正因子－0.000531415.校正的肌酐mg/dl=肌酐mg/dl-(葡萄糖×0.000531415)mg/dl腹膜透析基础PET:InterpretationPET评估D/PforUr,CrandNaandD/DoforGluat0,2,and4hrsarecalculatedPatientsareclassifiedonbasisof4hrD/PCraslow,lowaverage,highaverageorhightransportersIngeneral,hightransportersdialyzewell,butabsorbGlurapidly,havelessUF,greaterdialysateproteinlossesandlowerserumalbuminLowtransportersaretheoppositeandaveragetransportersareinbetween计算0、2、4小时的尿素、肌酐、钠的透析液浓度/血浆浓度(D/PUr,D/PCr,D/PNa)以及葡萄糖透析液浓度/血浆浓度(D/Do)按照4h时肌酐透析液浓度/血浆浓度(D/PCr)分为低、低平均、高平均或高转运患者总的来说，高转运患者透析好但是葡萄糖的吸收快，超滤量少，透析液丢失蛋白多，血清白蛋白也较低低转运患者与上述相反，平均转运者在两者之间腹膜透析基础CategorizationofperitonealtransportinPET

PET中腹膜转运特性的分类D/Pcreatinine肌酐D/D0glucose葡萄糖Drainvolume引流量High高转运Mean+1SDandaboveMean-1SDandbelowMean-1SDandbelowHighaverage高平均Mean+1SDMean-1SDMean-1SDLowaverage低平均Mean-1SDMean+1SDMean+1SDLow低转运Mean-1SDandbelowMean+1SDandaboveMean+1SDandabove腹膜透析基础患者比例％膜的类型4h时肌酐腹透液血清比(D/P)特性10%高转运0.82－1.03膜效率很高溶质转运快葡萄糖的吸收快达到超滤目标可能较难有低白蛋白血症的危险53%高平均0.65－0.81膜效率高溶质转运好超滤好31%低平均0