Continuous Ambulatory Peritoneal Dialysis for Children with End Stage Renal Disease

連續可㑺帶性腹膜透析對尿毒症患童之治療

邱益煊(Yee-Hsuan Chiou) ； 陳偉鵬(Wei-Perng Chen) ； CAPD小組(Capd Team) ； 林清淵(Ching-Yuang Lin)

《Acta Paediatrica Sinica》 31卷5期 (1990/10) Pp. 280-287

摘要

自民國76年6月至78年10月，共有10位尿毒症患童接受連續可携帶性腹膜透析(CAPD)治療，其開始CAPD治療之年齡由4歲到16歲，三男七女，引起尿毒症之原因計有：IgM間質細胞增生性腎炎3例，局部巢狀絲球硬化症3例，IgA間質細胞增生性腎炎1例，慢性腎絲球炎1例，全身性紅斑狠瘡合併腎炎l例，幼年型多囊性腎炎1例。每位病人治療之初，首先必須在腹腔內置放一根永久性之Tenckhoff氏導管，導管置妥後10至14天傷口完全癒合時，即可開始治療。在此等待期間，病人及其母親均在院內接受嚴格之教育及無菌操作訓練。CAPD小組之成員包括腎臟科醫師、CAPD專業護士、及營養師。大多數病人每日作四次交換，所使用之透析液爲Travenol公司所製之Dianeal PD-2。出院後初期每2週固定回來追踪檢查一次，所有患童在接受治療期間，BUN、Cr有顯著下降，血清磷在治療後明顯下降，血清鈣、膽固醇、三酸甘油脂則顯著上升。高血壓較易控制，貧血亦稍改善，所有患者均無蛋白質營養不良。在整個治療過程中，有三位患童各發生一次腹膜炎，每位病人平均每17.2個月才發生一次腹膜炎。10位病人中，三位己接受換腎移植，目前情況十分良好，其餘7位仍繼續CAPD治療中，而且均能上幼稚園或返校上學，這期間，其身高、體重亦有繼續成長。以上結果吾人認爲CAPD對尿毒症患童是一良好之療法。

並列摘要

From June 1986 to October 1989, ten children suffering from end stage renal disease (ESRD) were treated with continuous ambulatory peritoneal dialysis (CAPD). Their ages ranged from 4 to 16 years; 3 were boys and 7 were girls. IgM mesangial nephropathy (IgMN) (three cases) were the most common causes of renal failure in the patients. All patients were trained in the hospital. After CAPD treatment, serum BUN and creatinine dropped significantly. Serum levels of potassium, phosphorus, and alkaline phosphatase dropped and serum sodium and calcium rose significantly after treatment, Improvement of anemic state and control of hypertension were also noted. Hypercholesterolemia and hypertriglyceridemia developed after APD treatment. Despite protein loss through the peritoneal cavity, there was no evidence of protein malnutrition. Total serum protein and albumin increased significantly after treatment. The most common complication was peritonitis. Three of these 10 patients developed an episode of peritonitis, or an incidence of 1 episode per 17.2 patient months. To the present, seven patients are still doing well on CAPD. Three patients have received renal transplantation. The majority of the patients experienced an increased sense of well-being, easier diet and fluid management, freedom for travel and daily activities. Physical development also unproved, with body length and body weight gaining steadily. It can be concluded that CAPD is a good modality of long-term therapy for ESRD children.

並列關鍵字

continuous ambulatory peritoneal dialysis ； end stage renal disease