Peritoneal Dialysis in End-Stage Renal Disease Patients with Liver Cirrhosis and Ascites

腹膜透析在末期腎衰竭併肝硬化及大量腹水病人的治療經驗

陳建隆(Chien-Lung Chen) ； 張漢隆(Hang-Lung Chang) ； 王如玉(Ju-Yu Wang) ； 吳清平(Chin-Pyng Wu)

《重症醫學雜誌》 12卷3期 (2011/08) Pp. 100-104

https://doi.org/10.30035/TCCM.201108.0001

摘要

末期腎衰竭併有肝硬化及腹水的病人，常處於一種危急的狀態，很難以傳統的血液透析方式來治療，甚至是連續性的腎臟替代療法。因為容易加重血行動力狀態的不穩定及出血的危險性。對於這類病人，腹膜透析是一種較佳而且有效的治療選擇。腹膜透析不僅可以使血行動力狀態穩定，降低出血的危險性，提供更具彈性的操作方式，而且可以降低人力及設備成本的秏費。因此，我們搜集了3例末期腎衰竭併肝硬化及腹水而接受腹膜透析的病人。第一位是77歲的男性，充血性心衰竭、末期腎衰竭、C型肝炎併肝硬化及腹水，在接受6個月的血液透析後，因為嚴重的透析中低血壓及惡化的腹水，而轉為腹膜透析。第二位是53歲的男性，因糖尿病腎病變造成末期腎衰竭及Ｂ型肝炎併有大量腹水，而開始接受腹膜透析。第三位是75歲的女性，因為糖尿病腎病變造成末期腎衰竭、C型肝炎併大量腹水、充血性心衰竭，而接受腹膜透析。這三位病人對腹膜透析的耐受性都很好。即使治療初期，每天腹水的引流量在5000 c.c.以上，血行動力狀態仍能維持穩定。腹膜透析不須使用抗凝劑，可進行持續性的尿毒素清除，可經由透析液作能量補充，而且由於腹水的消除，可以提供病人較佳的生活品質。總之，末期腎衰竭併肝硬化及腹水或肝硬化併腹水惡化至末期腎衰竭是加護病房常遇到的狀況。相較於血液透析（HD）、連續性的血液過濾（CVVH）及低流速、低效率的每天血液透析（SLEDD），腹膜透析是一種較佳的治療選擇。

關鍵字

末期腎衰竭 ； 腹膜透析 ； 血液透析 ； 腹水 ； 肝硬化

並列摘要

End-stage renal disease (ESRD) patients with liver cirrhosis (LC) and ascites are in a critical status that is difficult to manage on conventional hemodialysis (HD) or continuous renal replacement therapy (CRRT) because of their hemodynamic instability and risk of bleeding. Peritoneal Dialysis (PD) offers them a viable alternative, along with a stable hemodynamic status, a lower risk of bleeding, a more flexible way of management, and a great reduction of staff as well as cost. Therefore, we collected 3 ESRD with liver cirrhosis and ascites patients to receive PD. The first patient was a 77-year-old man who had ESRD, hepatitis C virus (HCV) related LC and ascites, and congestive heart failure (CHF). He had received 6 months HD and shifted to PD because of shock during HD session and intractable ascites. The second patient was a 53-year-old man who had ERSD due to diabetes mellitus (DM) and hepatitis B virus (HBV) hepatitis with ascites. He chose PD because of advantage of home care. The third patient was a 75-year-old woman who had ESRD due to DM, CHF and HCV hepatitis with ascites. She chose PD because of hemodynamic instability. All of them tolerated PD well. Hemodynamic status was stable during PD even massive ascites (＞ 5,000 cc/d) was drained at the initial periods. No needs for anticoagulants, continuous solute clearance, caloric loading with glucose from dialysate, and drainage of ascites to maintain better life quality are advantages of PD.As patients of ESRD with LC and ascites or LC with ascites exacerbated to ESRD are frequently encountered in ICU, PD may be the better way than HD, Continuous Veno-Venous Hemofiltration (CVVH), or Slow Low Efficiency Daily Dialysis (SLEDD) to treat them.

並列關鍵字

End-stage renal disease (ESRD) ； Peritoneal dialysis (PD) ； Hemodialysis (HD) ； Ascites ； Liver cirrhosis (LC)