联合应用生物电阻抗及在线血容量监测评估血液透析患者干体质量的研究

目的联合应用生物电阻抗分析和在线血容量监测评估血液透析患者干体质量。方法选择240例石家庄市区健康志愿者及40例临床法评估均达到干体质量的维持性血液透析的患者,根据生物电阻抗分析法分为达干体质量亚组(8例)和未达干体质量亚组(32例)。应用MaltronBioScan916生物电阻抗仪测定对照组和病例组的体内水含量及分布[总体水含量占体质量的百分比(TBW%)、细胞外液占总体水含量的百分比(ECW/TBW%)、细胞内液占总体水含量的百分比(ICW/TBW%)]。使用Fresenius4008sBVM系统监测病例组初入组时未达干体质量亚组下调直至生物电阻抗法评估达干体质量后相对血容量的变化(ΔBV%)。结果未达干体质量亚组TBW%、ECW/TBW%、ICW/TBW%均与对照组差异有统计学意义(P0.05),但缓慢下调干体质量后与对照组比较差异无统计学意义(P0.05)。未达干体质量亚组调整干体质量前后分别与达干体质量亚组比较,△BV%差异无统计学意义(P0.05)。结论生物电阻抗分析法较临床评估法更准确评价透析患者的干体质量。联合应用生物电阻抗和在线血容量监测△BV%可以安全、准确地评估透析患者的干体质量。

Combined bioelectrical impedance and on-line blood volume monitoring on evaluating the dry weight in dialysis patients

Objective Combined with bioelectrical impedance analysis and on-line blood volume monitoring on estimating the dry weight in hemodialysis patients. Methods Control group：240 healthy volunteers in Shijiazhuang. Case group：40 hemodialysis patients who reached the dry weight were divided into two groups（sub-group of up to dry weight and sub-group of below the dry weight） ,according to the bioelectrical impedance analysis. Use of Maltron BioScan 916,we measured TBW%、ECW/TBW% and ICW/TBW% in control group and case group. Use of Fresenius 4008s BVM,we monitored ΔBV% in the patients who first entered Case group and the patients in sub-group of below the dry weight,when they reached the dry weight. Results Compared with Control group,TBW%、ECW/TBW% and ICW/TBW% in sub-group of below the dry weight all has statistical significance （P0.05）,but when the patients reached the dry weight,the above indexes has no statistical significance （P0.05）. Compared with sub-group of up to dry weight,ΔBV （%） in sub-group of below the dry weight before and after reached the dry weight both has no statistical significance （P0.05）. Conclusion Bioelectrical impedance analysis is more accurate than clinical assessment in evaluating the the dry weight. Combined with bioelectrical impedance analysis and on-line blood volume monitoring on estimating ΔBV（%）can be safely and accurately assess the dry weight in dialysis patients.