自動(dòng)化腹膜透析

自動(dòng)化腹膜透析處方調(diào)整日本2,500歐洲4,500其它4,400北美14,000總計(jì)25,4001996年全球APD病人分布情況‘95到‘96年的年增長(zhǎng)率為40％全球APD與CAPD占有情況Source:1996BaxterPatientReportUSEurope美國(guó)與歐洲APD與CAPD占有情況全球APD病人的增長(zhǎng)情況5,5009,00027,60021,00035,800HomeChoicePatientsAroundtheWorld9,2237622,9901,94527419822697Q1Total15618APD的不同類型夜間 ＋ ＋ ＋ ＋ 白天 ＋＋潮式 ＋＋非潮式＋ ＋每周進(jìn)展24小時(shí)，分3次或以上間歇進(jìn)展制定處方的根本要素體外表積(BSA)剩余腎功能(RRF)搜集24小時(shí)尿標(biāo)本每3個(gè)月測(cè)定一次腹膜轉(zhuǎn)運(yùn)特性規(guī)范PET開(kāi)場(chǎng)腹透治療2-4周后進(jìn)展充分性評(píng)價(jià)與調(diào)整充分性評(píng)價(jià)與處方調(diào)整臨床評(píng)價(jià)營(yíng)養(yǎng)評(píng)價(jià)去除率評(píng)價(jià)到達(dá)目的?是否繼續(xù)治療，無(wú)需調(diào)整處方處方調(diào)整常規(guī)隨訪，每4個(gè)月進(jìn)展一次充分性評(píng)價(jià)根據(jù)PET結(jié)果調(diào)整處方調(diào)整2－4周后重新進(jìn)展充分性評(píng)價(jià)Source:PeritonealDialysisPrescriptionManagementDecisionTree,1997充分性目的DOQIguidelinessuggest:ForCAPD-KT/Vureaof2.0perweekCreat.Clr.>60L/1.73mbodysurfacearea/wkForNIPD-KT/Vureaof2.2perweekCreat.Clr.>66L/1.73mbodysurfacearea/wkForCCPD-KT/Vureaof2.1perweekCreat.Clr.>63L/1.73mbodysurfacearea/wk222去除率目的Source:Blakeet.al.,PDI,1996CrClL/wk/1.73m2<4950-5960-69>70Kt/VWeekly<1.701.70-1.891.90-2.09>2.10GuidelinesUsecautionBorderlineAcceptableDesirable腹膜轉(zhuǎn)運(yùn)特性%患者 膜類型4小時(shí) 特性 肌酐D/P10% 高 .81-1.03 -腹膜效能非常高 -溶質(zhì)轉(zhuǎn)運(yùn)迅速 -葡萄糖吸收多 -能夠較難滿足超濾要求53% 高 .65-.81 -腹膜效能高 平均 -溶質(zhì)轉(zhuǎn)運(yùn)較迅速 -超濾可31% 低 .50-.65 -腹膜效能較低 平均 -溶質(zhì)轉(zhuǎn)運(yùn)速度較慢 -超濾較好6% Low .34-.50 -腹膜效能低 -溶質(zhì)轉(zhuǎn)運(yùn)速度慢 -無(wú)剩余腎功能時(shí)難以到達(dá)去除率目 標(biāo) -超濾很好亞洲腹透病人PET分布Sources:Transportclassifications:BaxterClinicaldatabase,USPDpatients,n=827,1995.PatientBSAderivedfromCross-sectionalStudyofNutrition,T.Chiku,1993.BodySurfaceAream21223344<1.401.40-1.75>1.75LowLowAverageHighAverageHigh6% 31% 53% 10%12344NoWetDayneededifPthasRRFRequireWetDay;maximizetheovernightfillvolDobestw/anadd’ldaytimeexchangeMostdifficulttodialyzeonanyPDtherapy1234APD總?cè)胍毫繉?duì)肌酐去除率的影響12.5L(4x2.5L+2.5L)12.5L(3x2.5L+2.5L+2.5L)15L(4x2.5+2.5L+2.5L)20LAPD(7x2.5L+2.5L)20LAPDDry(8x2.5L)白天“濕腹〞的重要性>90%的APD患者-除仍有剩余腎功能的高轉(zhuǎn)運(yùn)患者-需求白天濕腹以到達(dá)透析充分性目的>90%WetDay DryDay0%5%10%15%20%25%30%35%LowLowAverageHighAverageHigh40%45%50%6%31%53%10%白天“濕腹〞的重要性總?cè)胍毫客瑯訛?2L的APD治療，如運(yùn)用白天濕腹，那么可使去除率每周添加30％！Liters/WeekCreatinineClearance42.554.0Source:PDAdequest1.4Patient160cm,57kg,.724hrD/P10hrtherapy,dailyUF=1100APD處方調(diào)整PatientBSA 1.86m24oD/P 0.71RRF 0UF 1.5L10hourscyclerCrClL/wk/1.73m2TotalVolume 20L 10L 12.5L 12.5L CyclerNight 8X2.5L 4X2.0L 4x2.5L 3x2.5LDay Dry 2.0L 2.5L 2.5L+2.5LNightDwell(min) 41 112.5 112.5 160 Source:PDAdequestTMDatabase,1996LeastEfficient43.046.055.0MostEfficient678%20%21%57%APD彈性處方調(diào)整，提高透析去除率Source:PDAdequest1.4Patient160cm57kg.724hrD/P9hrtherapy,dailyUF=1100Liters/WeekCreatinineClearance2Lx5+2L2.5Lx4+2L2.5Lx3+2L+2L2Lx4+2L+1hour添加“濕腹〞

增參與液量

添加白天換液次數(shù)

延伸夜間上機(jī)時(shí)間51.157.367.161.6AverageSizePatient,HighAveragePET當(dāng)剩余腎功能下降時(shí)經(jīng)過(guò)調(diào)整APD方案和添加劑量，可提高肌酐去除率50-25--60-30NIPD