1、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)25,400,1996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: 1996 Baxter Patient Report,US,Europe,美國(guó)與歐洲APD與CAPD占有情況,全球APD病人的增長(zhǎng)情況,5,500,9,000,27,600,21,000,35,800,HomeChoice Patients Around the World,9,223,762,2,990,1,945,274,198,226,97 Q1,Total

2、15618,APD的不同類型,夜間 白天 潮式 非潮式 ,每周進(jìn)行24 小時(shí)，分3次 或以上間歇 進(jìn)行,制定處方的基本要素,體表面積 (BSA) 殘余腎功能 (RRF) 收集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 標(biāo)準(zhǔn) PET 開(kāi)始腹透治療2-4 周后進(jìn)行,充分性評(píng)估與調(diào)整,充分性評(píng)估與處方調(diào)整,臨床評(píng)估,營(yíng)養(yǎng)評(píng)估,清除率評(píng)估,達(dá)到目標(biāo)?,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)行一次充分性評(píng)估,根據(jù)PET結(jié)果調(diào)整處方 調(diào)整24周后重新進(jìn)行充分性評(píng)估,Source: Peritoneal Dialysis Prescription Management Decis

3、ion Tree, 1997,充分性目標(biāo),DOQI guidelines suggest: For CAPD - KT/V urea of 2.0 per week Creat. Clr. 60L/1.73m body surface area/wk For NIPD - KT/V urea of 2.2 per week Creat. Clr. 66L/1.73m body surface area/wk For CCPD - KT/V urea of 2.1 per week Creat. Clr. 63L/1.73m body surface area/wk,2,2,2,清除率目標(biāo),So

4、urce: Blake et. al., PDI, 1996,腹膜轉(zhuǎn)運(yùn)特性,% 患者 膜類型 4 小時(shí) 特性 肌酐 D/P 10% 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 - 可能較難滿足超濾要求 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)殘余腎功能時(shí)難以達(dá)到清除率目 標(biāo) - 超濾很好,亞洲腹透病人PET分布,Sources: Transport classificatio

5、ns: Baxter Clinical database, US PD patients, n=827, 1995. Patient BSA derived from Cross-sectional Study of Nutrition, T. Chiku, 1993.,Body Surface Area m2,1,2,2,3,3,4,4,1,2,3,4,4,No Wet Day needed if Pt has RRF,Require Wet Day; maximize the overnight fill vol,Do best w/ an addl daytime exchange,Mo

6、st difficult to dialyze on any PD therapy,1,2,3,4,APD總?cè)胍毫繉?duì)肌酐清除率的影響,12.5L (4x2.5L + 2.5L) 12.5L (3x2.5L + 2.5L + 2.5L) 15L (4x2.5 + 2.5L + 2.5L),20L APD (7x2.5L + 2.5L) 20L APD Dry (8x2.5L),白天“濕腹”的重要性, 90% 的APD患者 - 除仍有殘余腎功能的高轉(zhuǎn)運(yùn)患者- 需要白天濕腹以達(dá)到透析充分性目標(biāo), 90%,Wet Day Dry Day,0%,5%,10%,15%,20%,25%,30%,35%,Lo

7、w,Low Average,High Average,High,40%,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，如使用白天濕腹，則可使清除率每周增加30！,Liters/Week Creatinine Clearance,42.5,54.0,Source: PD Adequest 1.4 Patient 160 cm, 57 kg, .72 4 hr D/P 10 hr therapy, daily UF = 1100,APD 處方調(diào)整,Patient BSA1.86m2 4oD/P0.71 RRF0 UF1.5L 10 hours

8、 cycler,CrCl L/wk/1.73m2,Total Volume20L10L12.5L12.5L Cycler Night8X2.5L4X2.0L4x2.5L3x2.5L DayDry2.0L2.5L2.5L + 2.5L Night Dwell (min)41112.5112.5160,Source: PD AdequestTM Database, 1996,Least Efficient 43.0,46.0,55.0,Most Efficient 67,8%,20%,21%,57%,APD彈性處方調(diào)整，提高透析清除率,Source: PD Adequest 1.4 Patient 160 cm 57 kg .72 4 hr D/P 9 hr therapy, daily UF = 1100,Liters/Week Creatinine Clearance,2L x 5 + 2L,2.5L x 4 + 2L,2.5L x 3 + 2L + 2L,2L x 4 + 2L +1 hour,增加“濕腹” 增加入液量 增加白天換液次數(shù) 延長(zhǎng)夜間上機(jī)時(shí)間,51.1,57.3,67.1,61.6,Average Size Patient, High Average PET,當(dāng)殘余腎功能下降時(shí),通過(guò)調(diào)整APD方案和增加劑量，可提高肌酐清除率,Dialys