Mactier R A
Department of Medicine, Ninewells Hospital and Medical School, Dundee, Scotland.
Adv Perit Dial. 1991;7:57-62.
Apparent loss of peritoneal ultrafiltration capacity may occur when fluid intake is excessive, residual urine volumes decrease or the patient does not perform exchanges regularly and should be suspected if drain volumes are unchanged. True loss of ultrafiltration capacity (reduced drain volumes) is potentially reversible if due to catheter malposition, internal dialysate leakage or recent peritonitis but is usually permanent if kinetic studies indicate a sustained reduction in net transcapillary ultrafiltration or increased lymphatic drainage. Three types of irreversible ultrafiltration failure have been identified of which high peritoneal solute transport rates resulting in rapid dialysate glucose absorption (Type 1 membrane failure) is the most common. Transcapillary ultrafiltration may also be reduced due to very low peritoneal solute transport rates (Type 2 membrane failure) in patients with sclerosing peritonitis or massive peritoneal adhesions but is now rare. Ultrafiltration failure due to high lymphatic drainage (Type 3 failure) is also uncommon. Treatment strategies in patients with Type 1 failure include achieving the maximum urine output with diuretics, reducing fluid intake to the minimum tolerated by the patient, changing to short dwell exchanges (daytime ambulatory peritoneal dialysis (DAPD) or machine peritoneal dialysis overnight) and temporary hemodialysis which may lead to a spontaneous reduction in peritoneal transport rates in some patients. Patients with Type 2 and Type 3 failure require permanent transfer to hemodialysis.
当液体摄入量过多、残余尿量减少或患者未定期进行交换时，可能会出现明显的腹膜超滤能力丧失，如果引流液量没有变化，则应怀疑出现这种情况。如果超滤能力的真正丧失（引流液量减少）是由于导管位置不当、内部透析液渗漏或近期腹膜炎所致，则可能是可逆的，但如果动力学研究表明跨毛细血管超滤持续减少或淋巴引流增加，则通常是永久性的。已确定三种类型的不可逆超滤失败，其中导致透析液葡萄糖快速吸收的高腹膜溶质转运率（1型膜衰竭）最为常见。在患有硬化性腹膜炎或大量腹膜粘连的患者中，由于腹膜溶质转运率极低（2型膜衰竭），跨毛细血管超滤也可能降低，但现在这种情况很少见。由于高淋巴引流导致的超滤失败（3型衰竭）也不常见。1型衰竭患者的治疗策略包括使用利尿剂使尿量达到最大、将液体摄入量减少到患者能耐受的最低水平、改为短停留交换（日间非卧床腹膜透析（DAPD）或夜间机器腹膜透析）以及临时血液透析，在某些患者中，这可能会导致腹膜转运率自发降低。2型和3型衰竭患者需要永久性转为血液透析。
