腹透患者水和电解质的调控.ppt

腹膜透析患者的容量控制 山东省立医院肾内科 王荣 ESRD的流行病学状况 美国 欧洲 台湾 中国大陆 机会与挑战 肾脏替代治疗方式选择 肾移植 中心血液透析 腹膜透析 家庭血液透析 各种替代治疗的生存率 影响病人生存的主要因素—心血管事件 容量负荷的重要性 容量平衡对维持性透析患者至关重要 高血压、心衰常见，危害严重 普及相关知识，提高依从性，可显著提高病人生活质量及生存率 Difference in BP Control by Dialysis Modality as Reported by NKF Taskforce on CV Disease 高血压的发生率在血透患者中占 80%，腹透患者中占 50%左右 无论是腹透还是血透患者，高血压都没有很好的控制。相比之下，腹透患者控制好于血透患者 腹透患者血压低于血透患者归功于其缓慢超滤更成功地达到干体重 基础知识介绍 GENERAL PRINCIPLES OF TRANSPORT ACROSS THE PERITONEAL MEMBRANE surface area of the peritoneal membrane is between 1.0 and 1.3 m2 in adults only about one-third of the visceral peritoneum is in contact with the dialysis solution at a given time There are three barriers between the dialysate in the peritoneum and capillary blood: the capillary wall; the interstitium; and the mesothelial cell layer. Pores for solute transport small pores (average radius 40 to 50 ?) mediate the transport of lower molecular weight solutes The large pores constitute less than 0.1 percent of the total number of pores but are much larger than the small pores (average radius 150 ?) Ultrasmall pores (3 to 5 ?), which constitute the third pore, Aquaporin-1 Aquaporin-1 and water transport? the same water channel present in red blood cells and the proximal tubule, but different from aquaporin-2, which is the antidiuretic hormone-sensitive water channel in the collecting tubule Aquaporin-1 is present in the endothelial cells of the peritoneal microvasculature as the major water channel Peritoneal tissue also contains small numbers of aquaporin-3 and aquaporin-4 The aquaporin system is responsible for transcellular water transport induced by the osmotic gradient created by adding hypertonic dialysate to the peritoneum. it accounts for approximately 40 percent of total capillary ultrafiltration the small pore water transport is dependent upon non-osmotic determinants MTAC vs D/P The concept of mass transfer area coefficient represents the theoretical maximal peritoneal clearance by diffusion at time zero