【摘要】 目的 探讨应用扇形拨开器行腹膜透析(PD)置管术的临床效果。方法 选取行PD治疗的终末期肾病患者143例,随机分为术中应用扇形拨开器引导组(改良组)及常规手术组(常规组)。根据腹膜平衡试验(PET)将两组患者再分为4个亚组,即高转运组(A组)、高平均转运组(B组)、低平均转运组(C组)、低转运组(D组),对亚组营养及微炎症状况进行分析。结果(1)两组患者腹膜转运功能均以高平均转运和低平均转运类型多见。(2)在改良组与常规组中,A、B组患者改良定量主观整体评估(MQSGA)评分均高于C、D组,而上臂围、肱三头肌皮褶厚度(TSF)、BMI、血红蛋白、血清白蛋白、转铁蛋白均低于C、D组(P<0.05)。(3)与C、D组比较,A、B组的超敏C反应蛋白(hs-CRP)、IL-6、肿瘤坏死因子(TNF)-α水平更高(P<0.05)。(4)改良组中各亚组的MQSGA评分均低于常规组中的对应各亚组,而上臂围、TSF、BMI、血红蛋白、血清白蛋白、转铁蛋白的水平均高于常规组中的对应各亚组,其中以C组和D组显著(P<0.05)。改良组各亚组的hs-CRP、IL-6、TNF-α水平均低于常规组对应的各亚组,其中以C组和D组显著(P<0.05)。结论腹膜呈高转运状态的PD患者营养状况较差,体内炎症反应明显。应用扇形拨开器改良的PD置管术患者的营养状态优于行常规手术患者,且体内炎症反应较行常规手术患者轻。更多还原

【Abstract】 Objective To compare the effects of two different insertion of peritoneal dialysis(PD)catheter methods on nutritional and inflammation status.Methods A total of 143 cases of end-stage renal disease(ESRD) patients who inserted the PD catheters were divided into two groups randomly.Patients of improved group(n =72) were treated with sector apparatus to dispel guided insertion of PD catheter and patients in regular group(n = 71) were treated with conventional insertion.According to peritoneal equilibration test(PET) data,patients in each group were divided into high transport group(group A),average high transport group(group B),average low transport group(group C) and low transport group(group D).The nutritional and inflammation status of subgroups were compared to corresponding groups.Results(1) Average high transport and average low transport were the most common types in two groups.(2) In the improved group and regular group,patients in group A and B had higher modified quantitative subjective global assessment(MQSGA) scores and lower arm circumference,triceps skin fold thickness(TSF),BMI,hemoglobin,serum albumin and transferrin serum levels than those in group C and D(P <0.05).(3)Compared with group C and D.the levels of hypersensitive C-reactive protein(hs-CRP),interleukin(IL)-6,tumor necrosis factor(TNF)-α were higher in group A and B(P<0.05).(4)Compared with regular groups,4 improved groups had lower MQSGA scores and higher upper arm circumference,TSF,BMI,hemoglobin,serum albumin and transferrin levels,while differences from group C and D were significant(P <0.05).The serum levels of hs-CRP,IL-6 and TNF-α from improved group patients were lower than those from regular group,while differences from group C and group D were significant(P<0.05).Conclusion Poor nutritional status and heavy inflammatory response are frequently seen in PD patients with higher peritoneal transport.The patients accepted improved insertion of PD catheter have better nutritional status and slighter inflammation than those accepted conventional surgery.更多还原