Fischbach Michel, Dheu Céline, Helms Pauline, Terzic Joëlle, Michallat Anne Cécile, Laugel Vincent, Wolff-Danner Stéphanie, Haraldsson Borje
Nephrology Dialysis and Transplantation, Children's Unit, University Louis Pasteur, Strasbourg, France.
Perit Dial Int. 2005 Feb;25 Suppl 3:S137-40.
In children, the prescription of peritoneal dialysis is based mainly on the choice of the peritoneal dialysis fluid, the intraperitoneal fill volume (mL/m2 body surface area (BSA)], and the contact time. The working mode of the peritoneal membrane as a dialysis membrane is more related to a dynamic complex structure than to a static hemodialyzer. Thus, the peritoneal surface area impacts on dialysis adequacy. In fact, the peritoneal surface area may be viewed as composed of three exchange entities: the anatomic area, the contact area, and the vascular area. First, in infants, the anatomic area appears to be two-fold larger than in adults when expressed per kilogram body weight. On the other hand, the anatomic area becomes independent of age when expressed per square meter BSA. Therefore, scaling of the intraperitoneal fill volume by BSA (m2) is necessary to prevent a too low ratio of fill volume to exchange area, which would result in a functional "hyperpermeable" peritoneal exchange. Second, the contact area, also called the wetted membrane, is only a portion of the anatomic area, representing 30% to 60% of this area in humans, as measured by computed tomography. Both posture and fill volume may affect the extent of recruitment of contact area. Finally, the vascular area is influenced by the availability of both the anatomic area and the recruited contact area. This surface is governed essentially by both peritonealvascular perfusion, represented by the mesenteric vascular flow and, hence, by the number of perfused capillaries available for exchange. This vascular area is dynamically affected by different factors, such as composition of the peritoneal fluid, the fill volume, and the production of inflammatory agents. Peritoneal dialysis fluids that will be developed in the future for children should allow an optimization of the fill volume owing to a better tolerance in terms of lower achieved intraperitoneal pressure for a given fill volume. Moreover, future peritoneal dialysis fluids should protect the peritoneal membrane from hyperperfusion (lower glucose degradation products).
对于儿童，腹膜透析的处方主要基于腹膜透析液的选择、腹腔填充量（mL/平方米体表面积[BSA]）和接触时间。腹膜作为透析膜的工作模式与动态复杂结构的关系更大，而非与静态血液透析器相关。因此，腹膜表面积会影响透析充分性。实际上，腹膜表面积可被视为由三个交换实体组成：解剖学面积、接触面积和血管面积。首先，在婴儿中，按每千克体重计算，解剖学面积似乎比成人大一倍。另一方面，按每平方米BSA计算时，解剖学面积与年龄无关。因此，按BSA（平方米）对腹腔填充量进行校正很有必要，以防止填充量与交换面积的比例过低，这会导致功能性“高通透性”腹膜交换。其次，接触面积，也称为湿润膜，只是解剖学面积的一部分，通过计算机断层扫描测量，在人类中占该面积的30%至60%。姿势和填充量都可能影响接触面积的募集程度。最后，血管面积受解剖学面积和募集的接触面积两者可用性的影响。该表面主要由腹膜血管灌注决定，以肠系膜血管流量表示，因此由可用于交换的灌注毛细血管数量决定。这个血管面积会受到不同因素的动态影响，如腹膜液的成分、填充量和炎症介质的产生。未来为儿童开发的腹膜透析液应能优化填充量，因为在给定填充量下，腹腔内压力较低时耐受性更好。此外，未来的腹膜透析液应保护腹膜免受高灌注（降低葡萄糖降解产物）。
