Fischbach M, Terzic J, Dangelser C, Schneider P, Roger M L, Geisert J
Nephrology Dialysis Transplantation Children's Unit, Strasbourg, France.
Pediatr Nephrol. 1998 May;12(4):311-4. doi: 10.1007/s004670050460.
The posture of the patient influences both the intraperitoneal pressure (IPP) and the peritoneal permeability. We have studied the effects of the supine and the upright position in six children. Two peritoneal equilibration tests (PET) of 90-min dwell time each were performed consecutively, firstly in the supine position and then in the upright position. The same amount of dialysate was instilled (1,000 ml/m2; isotonic 1.36% dextrose) for each PET. Using the same filling volume, the IPP was significantly higher in the upright position (18.4 +/- 4.8 cm H2O) than in the supine position (8 +/- 2.4 cm H2O). The mean percentage IPP increase was 130% +/- 35%. The decline in glucose resorption rate from the dialysate during the PET was significantly lower in the upright position. Despite this greater relative loss of osmotic gradient in the upright than the supine position, no significant difference in net ultrafiltration was noted after 90 min of dwell. The peritoneal equilibration ratio during the PET was lower in the upright than the supine position for urea, creatinine, and phosphate. These results favor performing peritoneal dialysis in a supine position, both to increase dialysis efficiency and to reduce patient discomfort.
患者的体位会影响腹腔内压力（IPP）和腹膜通透性。我们研究了仰卧位和直立位对6名儿童的影响。连续进行了两次腹膜平衡试验（PET），每次留腹时间为90分钟，首先是仰卧位，然后是直立位。每次PET注入相同量的透析液（1000 ml/m²；等渗1.36%葡萄糖）。在相同的充盈量下，直立位时的IPP（18.4±4.8 cm H₂O）显著高于仰卧位（8±2.4 cm H₂O）。IPP平均增加百分比为130%±35%。PET期间透析液中葡萄糖重吸收率的下降在直立位时显著更低。尽管直立位时渗透梯度的相对损失比仰卧位时更大，但留腹90分钟后净超滤量没有显著差异。PET期间，直立位时尿素、肌酐和磷酸盐的腹膜平衡率低于仰卧位。这些结果表明，仰卧位进行腹膜透析有利于提高透析效率并减轻患者不适。
