【摘要】目的观察自动化腹膜透析在紧急起始腹膜透析患者的治疗效果、临床症状及并发症，总结应用自动化腹膜透析合理科学的护理方法。方法对在首都医科大学附属北京朝阳医院肾内科采用自动化腹膜透析(automsted peritoneal dialysis, APD)方式的患者30例，另随机选取30 例手工腹膜透析方式(continuous ambulatory peritoneal dialysis，CAPD)的患者，观察2组患者在紧急起始腹膜透析过程中的临床指标、导管相关并发症及超滤量等。结果治疗1周APD组平均超滤量为(721.133±392.830)ml，CAPD组平均超滤量为(354.833±157.011)ml，APD组高于CAPD组(t=1.743，P＜0.001)；APD组血肌酐为(655.295±161.847)μmol/L，CAPD 组血肌酐为(763.629±301.200)μmol/L，2 组结果无统计学差异(F=3.011，P=0.088)；APD组尿素氮为(18.803±6.122)mmol/L，CAPD组尿素氮为(25.542±7.364)mmol/L，APD组低于CAPD组(F=14.855，P＜0.001)。治疗2周后APD组血肌酐为(568.706± 133.833) μmol/L，CAPD组血肌酐为(716.389 ± 267.045)μmol/L，ADP 组低于CAPD 组(F=7.333，P=0.009)；APD 组尿素氮为(17.269 ± 5.499)mmol/L，CAPD 组尿素氮为(21.637 ± 6.383)mmol/L，ADP 组低于CAPD 组(F=8.061，P=0.006)。治疗4周后APD组血肌酐为(520.512±111.881)μmol/L，CAPD组血肌酐为(657.069±281.012)μmol/L，ADP组低于CAPD组(F=6.115，P=0.016)；APD组尿素氮为(14.376±4.502)mmol/L，CAPD组尿素氮为(18.197±4.583)mmol/L，ADP 组低于CAPD 组(F=10.614，P=0.002)，并发症方面：1 个月内腹膜炎APD 组0 例，CAPD 组1 例(χ2=1.017,P=0.313)；渗漏APD 组0 例，CAPD 组1 例(χ2=1.017,P=0.313)；外出口及隧道感染2 组各1 例(χ2=0.000，P =1.000)；腹腔出血APD 组1 例，CAPD 组2 例(χ2=0.351，P =0.554)；腹痛2 组各2 例(χ2=0.000,P =1.000)；管路移位APD 组0 例，CAPD 组2 例(χ2=2.069,P=0.150)；引流不畅2 组各4 例(χ2=0.000,P=1.000)，均无统计学差异。结论自动化腹膜透析作为新置管术后开始紧急腹膜透析方式具有可行性、减少护士工作量、不影响患者术后休息及培训。

【Abstract】Objective To observe the therapeutic effect, clinical parameters and complications of automated peritoneal dialysis (APD) for patients with urgent-start dialysis, and to summarize the suitable and scientific nursing methods for APD. Methods Thirty patients treated with APD in the Department of Nephrology, Beijing Chaoyang Hospital Affiliated to Capital Medical University were enrolled as the APD group, and 30 patients treated with continuous ambulatory peritoneal dialysis (CAPD) were randomly selected as the CAPD group. Clinical parameters, catheter- related complications and ultrafiltration volume in the processes of urgent-start peritoneal dialysis were observed in the two groups. Results In the first week, the average ultrafiltration volume was higher in APD group than in CAPD group (721.133 ± 392.830 ml vs. 354.833 ±157.011 ml; t=1.743，P＜0.001); serum creatinine was similar between APD group and CAPD group (655.295±161.847 μmol/L vs. 763.629±301.200 μmol/L; F= 3.011, P=0.088); urea nitrogen was lower in APD group than in CAPD group (18.803 ± 6.122 mmol/L vs. 25.542 ± 7.364 mmol/L; F=14.855, P<0.001). In the second week, serum creatinine was lower in APD group than in CAPD group (568.706 ± 133.833 μmol/L vs.716.389±267.045 μmol/L; F=7.333, P=0.009); urea nitrogen was lower in APD group than in CAPD group

(17.269±5.499 mmol/L vs. 21.637±6.383 mmol/L; F=8.061, P=0.006). In the fourth week, serum creatinine was lower in APD group than in CAPD group (520.512 ± 111.881 μmol/L vs. 657.069 ± 281.012 μmol/L;F=6.115, P=0.016); urea nitrogen was lower in APD group than in CAPD group (14.376±4.502 mmol/L vs. 18.197±4.583mmol/L; F=10.614,P=0.002). Complications occurred in the two groups: peritonitis within the first month, 0 case in APD group and one case in CAPD group (χ2=1.017, P=0.313); leakage, 0 case in APD group and one case in CAPD group (χ2=1.017, P=0.313); exit or tunnel infection, one case in each group (χ2=0.000, P=1.000); intraperitoneal hemorrhage, one case in APD group and 2cases in CAPD group (χ2=0.351, P=0.554); abdominal pain, 2 cases in each group (χ2=0.000, P=1.000); tube displacement, 0 case in APD group and 2 cases in CAPD group (χ2=2.069, P=0.150); inadequate drainage, 4 cases in each group(χ2=0.000, P=1.000). Conclusion Automated peritoneal dialysis is a new method of urgent-start dialysis and is clinically useful. This method causes less disturbance to patients’rest and dialysis training as well as less workload to nurses.