【作者】 王璐；

【导师】 赵久阳； 孙晶娣；

【作者基本信息】 大连医科大学 ， 内科学， 2013， 硕士

【摘要】 目的：探讨不同钙浓度腹膜透析液对持续性非卧床腹膜透析(continuous ambulatoryperitoneal dialysis，CAPD)患者血清钙磷及全段甲状旁腺素的影响。方法：回顾性分析:选取于我院2010年8月-2012年10月行持续性非卧床腹膜透析(CAPD)治疗的患者64名，2010年8月至2011年8月期间使用钙浓度为1.75mmol/l腹膜透析液，2011年8月起全部更换为钙浓度1.25mmol/l的透析液。比较同一个腹膜透析患者，依次使用钙浓度为1.75mmol/l的腹膜透析液(PD2组)及钙浓度为1.25mmol/l的透析液(PD4组)对比前后的钙磷及血清全段甲状旁腺素(intact parathyroidhormone，iPTH)的指标。首先，将入组患者根据使用PD2腹透液的时间长短分为A组(小于1年)，B组(1-3年)及C组(大于3年)三组，分别检测使用PD2腹透液及PD4腹透液前后三组血清钙、磷、iPTH水平；其次，分别比较使用PD2腹透液及PD4腹透液透析前后血清钙达标率、高血钙发生率、低血钙发生率。结果：1.随着使用PD2腹透时间的延长，患者体内血钙、磷、iPTH水平均升高(P＜0.05)。2.应用PD2腹透液大于3年(C组)的患者，改为使用PD4腹透液后，较使用前血磷水平明显升高，P＜0.05。3.使用PD2腹透液透析后血清钙达标率无明显变化，与透析前比较无统计学意义，P＞0.05；使用PD2腹透液透析后低血钙发生率明显降低，与透析前比较有统计学意义，P＜0.05；使用PD2腹透液透析后高血钙发生率明显升高，与透析前比较有统计学意义，P＜0.05。4.使用PD4腹透液透析后血清钙达标率明显升高，与透析前比较有统计学意义，P＜0.05；使用PD4腹透液透析后低血钙发生率明显降低，与透析前比较有统计学意义，P＜0.05；使用PD4腹透液透析后血清钙高血钙发生率无明显变化，与透析前比较无统计学意义，P＞0.05。结论：1.使用PD2腹透液能纠正低血钙，但增加高钙血症的发生率。2.使用PD4腹透液能提高血钙的达标率。3.随着透析龄的延长，使用PD2及PD4腹透液均不能纠正高磷血症及高血PTH。更多还原

【Abstract】 Objective: To investigate the effect of different dialysate calcium concentrations oncalcium and phosphorus and serum intact parathyroid hormone.Methods: A retrospective analysis comparing the indicators of serum calcium,phosphorus and intact parathyroid hormone (iPTH) in peritoneal dialysis patients whoreceived the treatment of peritoneal dialysate with a calcium concentration of1.75mmol/l of (PD2group) before August2011and that with a calcium concentration of1.25mmol/l (PD4group) after August2011. Firstly, according to the duration of usingPD2dialysate, the subjects were divided into group A (less than1year), group B (1to3years) and group C (more than3years). Serum calcium, phosphorus, and iPTH levels ofthe three groups were compared before and after using PD2and then after using PD4dialysate. Secondly, the serum calcium levels of the patients were compared before andafter using PD2and PD4dialysate. Serum calcium standardization rate, incidence ofhypercalcemia, and incidence of hypocalcemia were calculated.Results:1. The serum calcium, phosphorus and iPTH in patients were significantlyincreased (P <0.05) after using PD2dialysate.2. The serum phosphorus of group Cusing PD4dialysate who used PD2dialysate more than3years was significantly higher(P <0.05).3. After using PD2dialysate dialysis, the standardization rate of serumcalcium was not statistically significant compared with that of pre-dialysis (P>0.05),and the incidence of hypocalcemia was statistically significantly decreasing comparedwith that of pre-dialysis (P <0.05),and the incidence of hypercalcemia was statisticallysignificantly increasing compared with that of pre-dialysis (P <0.05).4. After using PD4dialysate, the standardization rate of serum calcium was statistically significantlyincreasing compared with that of pre-dialysis (P <0.05), and the incidence of hypocalcemia statistically significantly reduced compared with that of pre-dialysis (P<0.05), and the incidence of hypercalcemia changed remarkably compared with that ofpre-dialysis (P>0.05).Conclusion:1. Using PD2peritoneal dialysate could help to correct hypocalcemia, butit increased the incidence of hypercalcemia.2. Using PD4dialysate could help to increase the standardization rate ofserum calcium.3. With increase in the duration of dialysis, serum phosphorus graduallyincreased. Hyperphosphatemia and high serum PTH could not be corrected even withPD2and PD4dialysate use.更多还原