Durand P Y, Chanliau J, Gamberoni J, Hestin D, Kessler M
Altir & Nephrology Department, Chru Nancy, France.
Adv Perit Dial. 1994;10:63-7.
In automated peritoneal dialysis (APD) patients treated with 3-L dwell, intraperitoneal volumes can easily be increased up to 4 or 4.5 L using hypertonic solutions without objective control of their good tolerance. In 20 adult patients treated with continuous ambulatory peritoneal dialysis (CAPD) in good conditions, hydrostatic intraperitoneal pressure (IPP) and pulmonary vital capacity (VC) were measured in strict supine position, after infusing isotonic dialysate in 0.5-L increments from 2 up to 5 L as tolerated, according to intraperitoneal volumes (IPV). None of the patients had cardiac or pulmonary dysfunction. IPP was measured following a routine method previously described. In all cases, experience was stopped when IPP increased over 20 cm H2O and/or VC decreased over 25%. IPV is linearly and positively correlated with IPP (p < 0.0001), and negatively with VC (p = 0.0012), but the reliability of VC is less than that of IPP, particularly in old patients. Clinical symptomatology of bad IPV tolerance never occurred alone and was always associated with an increase in IPP over 20 cmH2O and/or a decrease in VC over 25%. The maximal acceptable IPV is better defined by an IPP less than 18 cmH2O, according with a decrease in VC of less than 20%. Routine measurement of IPP can be used to determine maximal IPV and for optimal PD prescription.
在接受3L留腹治疗的自动腹膜透析（APD）患者中，使用高渗溶液可轻松将腹腔内液体量增加至4L或4.5L，而无需客观控制其耐受性。对20例病情良好的持续性非卧床腹膜透析（CAPD）成年患者，在严格仰卧位下，根据腹腔内液体量（IPV），以0.5L的增量从2L开始逐渐输注等渗透析液，直至耐受的5L，测量静水压性腹腔内压力（IPP）和肺肺活量（VC）。所有患者均无心脏或肺部功能障碍。IPP按照先前描述的常规方法测量。在所有情况下，当IPP升高超过20cmH₂O和/或VC降低超过25%时，停止试验。IPV与IPP呈线性正相关（p<0.0001），与VC呈负相关（p = 0.0012），但VC的可靠性低于IPP，尤其是在老年患者中。腹腔内液体量耐受性差的临床症状从未单独出现，总是与IPP升高超过20cmH₂O和/或VC降低超过25%相关。最大可接受的IPV通过IPP小于18cmH₂O且VC降低小于20%来更好地定义。常规测量IPP可用于确定最大IPV并进行最佳腹膜透析处方。
