腹膜透析患者的腹膜内压的影响因素与临床管理
摘要
依赖肾脏替代治疗来维持生命，腹膜透析（Peritoneal Dialysis，PD）是一种常用于治疗 ESRD的肾脏替代治疗方式。
该方法利用腹膜作为半透膜，通过将透析液注入腹腔与血液中的废物和多余液体进行交换，从而实现毒素和多余液体
的排出。腹膜内压（Intraperitoneal Pressure，IPP）是在腹膜透析过程中，腹腔内透析液对腹腔壁的静水压力，随着透析
液的注入，腹膜内压的增加呈线性上升[1]。近年来，PD患者使用Durand技术测量 IPP，每增加1 L容积，IPP线性增加
2.2 cmH2O[2]。过高的腹膜内压不仅会影响透析效果，尤其是超滤效率和溶质清除，还会增加并发症的发生风险，长期
腹腔内压升高可能导致腹腔渗漏、腹壁疝气、胸腔积他严重并发症[3][4]。因此监测腹膜透析患者的腹内压对于保证治疗
效果和预防并发症至关重要，现对PD患者腹膜内压的测量方法、影响因素、并发症的关系及管理干预措施作此综述。
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[1]Hao J, A B, Xu Y, Ma T, Dong J. Association of
intraperitoneal pressure and clinical symptoms in peritoneal
dialysis patients. Chinese Journal of Nephrology. 2023 May
15;345–52.
[2]Durand PY, Chanliau J, Gambéroni J, Hestin
D, Kessler M. Measurement of hydrostatic intraperitoneal
pressure: a necessary routine test in peritoneal dialysis. Perit
Dial Int. 1996;16 Suppl 1:S84-87.
[3]Outerelo MC, Gouveia R, Teixeira e Costa F,
Ramos A. Intraperitoneal pressure has a prognostic impact on
peritoneal dialysis patients. Perit Dial Int. 2014;34(6):652–4.
[4]Bargman JM. Complications of peritoneal dialysis
related to increased intraabdominal pressure. Kidney Int
Suppl. 1993 Feb;40:S75-80.
[5]Kimball EJ, Kim W, Cheatham ML, Malbrain
MLNG. Clinical awareness of intra-abdominal hypertension
and abdominal compartment syndrome in 2007. Acta Clin
Belg. 2007;62 Suppl 1:66–73.
[6]Fusco MA, Martin RS, Chang MC. Estimation of
intra-abdominal pressure by bladder pressure measurement:
91
现代医学前沿 | 第2卷/第11期
Advances in Mordern Medical
validity and methodology. J Trauma. 2001 Feb;50(2):297–302.
[7 ]Davi s P J, Koottayi S, Taylo r A, Butt WW.
Comparison of indirect methods of measuring intraabdominal pressure in children. Intensive Care Med. 2005
Mar;31(3):471–5.
[8]Al-Hwiesh A, Al-Mueilo S, Saeed I, Al-Muhanna
FA. Intraperitoneal pressure and intra-abdominal pressure: are
they the same? Perit Dial Int. 2011;31(3):315–9.
[9]Durand PY, Chanliau J, Gamberoni J, Hestin
D, Kessler M. Routine measurement of hydrostatic
intraperitoneal pressure. Adv Perit Dial. 1992;8:108–12.
[10]Castellanos LB, Clemente EP, Cabañas CB,
Parra DM, Contador MB, Morera JCO, Daly JA. Clinical
Relevance of Intraperitoneal Pressure in Peritoneal Dialysis
Patients. Perit Dial Int. 2017 Sep;37(5):562–7.
[11]Thangarasa T, Foisy D, Leidecker J, Corsi DJ,
Meggison H, Blew B, Warren J, Zimmerman D. In Search of
a Simple and Reliable Method of Measuring Intra-abdominal
Pressure in Peritoneal Dialysis Patients. Can J Kidney Health
Dis. 2019;6:2054358119892695.
[12]Li X, Ma T, Hao J, Song D, Wang H, Liu T,
Zhang Y, Abi N, Xu X, Zhang M, Sun W, Li X, Dong J.
Novel equations for estimating intraperitoneal pressure among
peritoneal dialysis patients. Clinical Kidney Journal. 2023 Aug
31;16(9):1447–56.
[13]Intra-abdominal pressure, peritoneal dialysis
exchange volume, and tolerance in APD - PubMed [Internet].
[cited 2024 Nov 8]. Available from: https://pubmed.ncbi.
nlm.nih.gov/12437534/
[14]Schneditz D, Sauseng N, Pütün E, Rosenkranz
AR, Ribitsch W. Supine equilibration of extracellular fluid in
peritoneal dialysis varies with intra-abdominal pressure. Perit
Dial Int. 2020 Sep;40(5):477–86.
[15]钟远，陆石，李保春，唐令诠.老年人腹膜透析
腹内压增高相关性并发症的临床研究.肾脏病与透析肾移
植杂志.1998；（4）：38–40.
[16]Watanabe H, Enoki Y, Maruyama T. Sarcopenia
in Chronic Kidney Disease: Factors, Mechanisms,
and Therapeutic Interventions. Biol Pharm Bull.
2019;42(9):1437–45.
[17]Isoyama N, Qureshi AR, Avesani CM, Lindholm
B, Bàràny P, Heimbürger O, Cederholm T, Stenvinkel
P, Carrero JJ. Comparative associations of muscle mass and
muscle strength with mortality in dialysis patients. Clin J Am
Soc Nephrol. 2014 Oct 7;9(10):1720–8.
[18]Yang SF, Liu CJ, Yang WC, Chang CF, Yang CY,
Li SY, Lin CC. The risk factors and the impact of hernia
development on technique survival in peritoneal dialysis
patients: a population-based cohort study. Perit Dial Int.
2015;35(3):351–9.
[19]Ma GU, Cr R, V VR, Fj CH, E FR, Jm VG, M
VG. Prevalence and management of hernias in peritoneal
dialysis patients. Peritoneal dialysis international : journal of
the International Society for Peritoneal Dialysis [Internet].
2006 Apr [cited 2024 Nov 8];26(2). Available from: https://
pubmed.ncbi.nlm.nih.gov/16623425/
[20]Brainwood M, Beirne G, Fenech M. Persistence
of the processus vaginalis and its related disorders. Australas J
Ultrasound Med. 2020 Feb;23(1):22–9.
[21 ] I nt e r n ati o n al g ui d eli n e s f o r g r oi n h e r ni a
management. Hernia : the journal of hernias and abdominal
wall surgery [Internet]. 2018 Feb [cited 2024 Nov 8];22(1).
Available from: https://pubmed.ncbi.nlm.nih.gov/29330835/
[22]Luk Y, Li JYY, Law TT, Ng L, Wong KY.
Tension-free mesh repair of inguinal hernia in patients on
continuous ambulatory peritoneal dialysis. Perit Dial Int. 2020
Jan;40(1):62–6.
[23]Lew SQ. Peritoneal Dialysis Immediately after
Abdominal Surgery. Perit Dial Int. 2018;38(1):5–8.
[24]Chow CC, Sung JY, Cheung CK, Hamilton-Wood
C, Lai KN. Massive hydrothorax in continuous ambulatory
peritoneal dialysis: diagnosis, management and review of the
literature. N Z Med J. 1988 Jul 27;101(850):475–7.
[25]Molsted S, Eidemak I. Musculoskeletal pain reported
by mobile patients with chronic kidney disease. Clin Kidney J.
2020 Oct;13(5):813–20.
[26]Krishna SR, Madhavi K, Kishore CK, Kumar VS.
Effect of exercise program on lumbosacral strain in patients on
continuous ambulatory peritoneal dialysis. Indian J Nephrol.
2014 Jul;24(4):262–3.
[27]Siafakas NM, Argyrakopoulos T, Andreopoulos
K, Tsoukalas G, Tzanakis N, Bouros D. Respiratory muscle
strength during continuous ambulatory peritoneal dialysis
(CAPD). Eur Respir J. 1995 Jan;8(1):109–13.
[28]Zhang J, Song L, Ma Z, Sun L, Wang X, Liu D,
Huang F, Man Y. Intra-abdominal pressure and residual
renal function decline in peritoneal dialysis: a threshold-based
investigation. Renal Failure. 2024 Dec 31;46(1):2312535.
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