腹膜透析患者容量管理的最佳证据总结

doi:10.3761/j.issn.1672-9234.2025.03.018

摘要/Abstract

摘要：

目的总结腹膜透析患者容量管理的高质量证据，为临床实践提供科学依据。方法系统检索国内外数据库和相关专业网站中与腹膜透析患者容量管理相关的文献，检索时限设定为2012年1月1日至2024年6月1日。2名经过系统循证知识培训的研究者根据明确的纳入和排除标准，独立进行文献筛选、质量评价、证据提取和汇总。结果共纳入文献13篇，包括指南6篇、专家共识2篇、证据总结2篇、系统评价2篇、临床决策1篇。总结28条腹膜透析患者容量管理的最佳证据。结论研究总结了关于腹膜透析患者容量管理的最佳实践证据，具有一定的实践价值，可为医疗工作者进行腹膜透析患者的容量管理提供了有力的循证支持。

关键词: 腹膜透析, 容量管理, 证据总结, 循证护理

Abstract:

Objective To summarize high-quality evidence-based evidence for volume management in peritoneal dialysis patients and provide a scientific reference for clinical practice. Methods Systematically searching was undertaken first for literature related to volume management in peritoneal dialysis patients in both domestic and international databases as well as relevant professional websites. Time limit was set from January 1，2012，to June 1，2024. After that，two researchers who had undergone systematic evidence-based knowledge training had done literature screening，quality assessment，evidence extraction，and synthesis based on clear inclusion and exclusion criteria independently. Results A total of 13 articles were included，comprising six guidelines，two expert consensuses，two evidence summaries，two systematic reviews，and one clinical decision. A total of 28 pieces of best evidence for volume management in peritoneal dialysis patients were summarized. Conclusion This study summarizes the best practice evidence for volume management in peritoneal dialysis patients，which holds certain practical value and provides robust evidence-based support for healthcare providers in managing the volume status of peritoneal dialysis patients.

Key words: Peritoneal Dialysis, Volume Management, Evidence Summary, Evidence-Based Nursing

徐文琪, 韩慧敏, 郭畔旭, 刘颖珂, 刘京辉, 李小利, 杨长永, 章明阳. 腹膜透析患者容量管理的最佳证据总结[J]. 中华护理教育, 2025, 22(3): 371-378.

XU Wenqi, HAN Huimin, GUO Panxu, LIU Yingke, LIU Jinghui, LI Xiaoli, YANG Changyong, ZHANG Mingyang. Best evidence summary for volume management in peritoneal dialysis patients[J]. Chinese Journal of Nursing Education, 2025, 22(3): 371-378.

图/表 5

参考文献 35

[1]	《中国腹膜透析管理现状白皮书》项目组. 中国腹膜透析管理现状白皮书[J]. 中华肾脏病杂志, 2022, 38(12):1076-1104.
[2]	许义, 汪小华. 腹膜透析患者容量负荷评估及容量管理的研究进展[J]. 护理管理杂志, 2013, 13(9):632-634.
[3]	Ng JK, Kwan BC, Chow KM, et al. Asymptomatic fluid overload predicts survival and cardiovascular event in incident Chinese peritoneal dialysis patients[J]. PLoS One, 2018, 13(8):e0202203.
[4]	赵彩萍, 杨春芳, 王丽, 等. 腹膜透析患者容量超负荷的危险因素及风险评估模型的研究[J]. 中国血液净化, 2020, 19(11):738-741.
	Zhao CP, Yang CF, Wang L, et al. The development of a risk prediction model for volume overload in patients with peritoneal dialysis[J]. Chin J Blood Purif, 2020, 19(11):738-741.
[5]	范孟杰, 田凤美, 王赟, 等. 腹膜透析患者容量管理行为的异质性及影响因素分析[J]. 护理学杂志, 2024, 39(10):35-40.
	Fan MJ, Tian FM, Wang Y, et al. Analysis of heterogeneity and influencing factors of volume management behavior in peritoneal dialysis patients[J]. J Nurs Sci, 2024, 39(10):35-40.
[6]	周润哲, 杨相杰, 孟雨晴, 等. 腹膜透析患者液体状态与肺动脉高压的相关性[J]. 临床肾脏病杂志, 2023, 23(7):529-535.
	Zhou RZ, Yang XJ, Meng YQ, et al. Association between fluid status and pulmonary hypertension in peritoneal dialysis patients[J]. J Clin Nephrol, 2023, 23(7):529-535.
[7]	中国医师协会肾脏内科医师分会心肾综合征指南工作组. 心肾综合征诊疗的临床实践指南(2023版)[J]. 中华医学杂志, 2023, 103(46):3705-3759.
[8]	Kidney Disease:Improving Global Outcomes(KDIGO) CKD Work Group. KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease[J]. Kid-ney Int, 2024, 105(4s):S117-S314.
[9]	朱政, 胡雁, 邢唯杰, 等. 不同类型循证问题的构成[J]. 护士进修杂志, 2017, 32(21):1991-1994.
[10]	Foster MJ, Shurtz S. Making the critical appraisal for summa-ries of evidence(CASE) for evidence-based medicine (EBM):critical appraisal of summaries of evidence[J]. J Med Libr Assoc, 2013, 101(3):192-198.
[11]	Lang J, Haines K. Clinimetrics:appraisal of guidelines,resear-ch and evaluation Ⅱ[J]. J Physiother, 2019, 65(3):176.
[12]	Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2:a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions,or both[J]. BMJ, 2017,358:j4008.
[13]	周英凤, 胡雁, 朱政, 等. JBI循证卫生保健中心文本证据的质量评价清单[J]. 护士进修杂志, 2024, 39(10):1075-1080.
[14]	曹培叶, 赵慧萍, 武蓓, 等. 成人腹膜透析患者管理的最佳证据总结[J]. 中国血液净化, 2023, 22(7):551-556.
	Cao PY, Zhao HP, Wu B, et al. Evidence summary about the management of adult patients with peritoneal dialysis[J]. Chin J Blood Purif, 2023, 22(7):551-556.
[15]	慢性肾脏病高血压管理共识专家组. 非透析和透析慢性肾脏病患者高血压管理的中国专家共识[J]. 中华内科杂志, 2023, 62(7):748-774.
[16]	Horowitz L, Karadjian O, Braam B, et al. Bioimpedance-guided monitoring of volume status in patients with kidney disease:a systematic review and meta-analysis[J]. Can J Kidney Health Dis, 2023,10:20543581231185433.
[17]	李苗苗, 安李一, 陆巍, 等. Ⅳ型心肾综合征腹膜透析患者容量管理的最佳证据总结[J]. 护理学报, 2020, 27(22):39-44.
[18]	Burkart JM. Management of hypervolemia in patients on peri-toneal dialysiss[EB/OL].(2024-04-09)[2024-08-29]. http://www.uptodate.cn.
[19]	Kharat A, Tallaa F, Lepage MA, et al. Volume status assess-ment by lung ultrasound in end-stage kidney disease:a systematic review[J]. Can J Kidney Health Dis, 2023,10:205-43581231217853.
[20]	谭荣韶, 于康, 窦攀, 等. 成人慢性肾脏病食养指南(2024年版)[J]. 卫生研究, 2024, 53(3):357-362.
	Tan RS, Yu K, Dou P, et al. Guidelines on diet and nutrition for adult chronic kidney disease(2024 edition)[J]. J Hyg Res, 2024, 53(3):357-362.
[21]	中华医学会肾脏病学分会, 中关村肾病血液净化创新联盟. 中国透析患者慢性心力衰竭管理指南[J]. 中华肾脏病杂志, 2022, 38(5):465-496. doi: 10.3760/cma.j.cn441217-20210812-00068
[22]	《中国围透析期慢性肾脏病管理规范》专家组. 中国围透析期慢性肾脏病管理规范[J]. 中华肾脏病杂志, 2021, 37(8):690-704. doi: 10.3760/cma.j.cn441217-20210322-00104
[23]	Ikizler TA, Burrowes JD, Byham-Gray LD, et al. KDOQI clinical practice guideline for nutrition in CKD:2020 update[J]. Am J Kidney Dis, 2020, 76(3Suppl 1): S1-S107.
[24]	Kharat A, Tallaa F, Lepage MA, et al. Volume status assessment by lung ultrasound in end-stage kidney disease:a systematic review[J]. Can J Kidney Health Dis, 2023,10:205435812312-17853.
[25]	Loutradis C, Sarafidis PA, Ferro CJ, et al. Volume overload in hemodialysis:diagnosis,cardiovascular consequences,and ma-nagement[J]. Nephrol Dial Transplant, 2021, 36(12):2182-2193.
[26]	丁小强, 吉俊. 持续非卧床腹膜透析腹膜功能减退影响因素和干预策略[J]. 中国实用内科杂志, 2013, 33(6):419-422.
[27]	白梦婷, 李思宇, 程力. 腹膜透析患者治疗后腹膜溶质转运速率升高危险因素分析[J]. 陕西医学杂志, 2024, 53(7):944-948.
[28]	陈香美. 腹膜透析标准操作规程:2010版[M]. 北京: 人民军医出版社, 2010.
[29]	刘晨曦, 夏鸣, 刘虹. 糖尿病肾脏病腹膜透析患者管理策略[J]. 中国血液净化, 2024, 23(3):200-203.
	Liu CX, Xia M, Liu H. Management of patients with diabetic end-stage renal disease on peritoneal dialysis[J]. Chin J Blood Purif, 2024, 23(3):200-203.
[30]	徐光, 陶雅非, 鲁冰, 等. 维持性腹膜透析患者血压变异性的相关影响因素[J]. 临床肾脏病杂志, 2023, 23(11):916-920.
	Xu G, Tao YF, Lu B, et al. Factors associated with blood pressure variability in patients on maintenance peritoneal dialysis[J]. J Clin Nephrol, 2023, 23(11):916-920.
[31]	许义. 容量管理对持续非卧床腹膜透析患者容量负荷及心功能的影响[D]. 苏州: 苏州大学, 2014.
[32]	Bennett PN, Bohm C, Harasemiw O, et al. Physical activity and exercise in peritoneal dialysis:International Society for Peritoneal Dialysis and the Global Renal Exercise Network practice recommendations[J]. Perit Dial Int, 2022, 42(1):8-24.
[33]	李娟, 卢婉君, 龚书豪, 等. 慢性肾衰竭腹膜透析患者微炎症状态的研究进展[J]. 南昌大学学报(医学版), 2021, 61(3):80-83.
[34]	Luft FC. Cardiovascular risk in patients with end-stage renal disease[J]. Indian J Nephrol, 2001, 11(3):77.
[35]	韩庆烽. 腹膜透析患者心脑血管疾病的危险因素[J]. 中国血液净化, 2018, 17(8):505-507.