腹膜透析病人体内水分布与营养状况的关系

目的:了解持续性不卧床腹膜透析(CAPD)病人体内水的分布状况及其与营养之间的关系。方法:用生物电阻抗法对66名无临床水肿表现的CAPD病人进行体内水的测量,分别测出其细胞外液(ECW)、细胞内液(ICW)、总体水(TBW),同时对所有病人进行营养状况的主观综合评价(SGA)。相同年龄段的正常人作为对照。结果:临床无水肿的CAPD病人与相同年龄的正常人相比,体内水的分布存在明显异常,表现为细胞内液显著减少,细胞外液无明显变化,细胞外液与细胞内液之比(E/I)明显增加;当病人存在营养不良时,上述现象表现得更加明显。结论:持续性不卧床式腹膜透析(CAPD)病人体内水的分布是异常的,营养不良可以加重体内水的异常分布。因此,对于临床无明显水肿表现但存在营养不良的CAPD病人不能通过E/I来判断体内是否存在水负荷过多。

RELATIONSHIP BETWEEN NUTRITIONAL STATUS AND FLUID DISTRIBUTION IN CONTINUOUS AMBULATORY PERITONEAL DIALYSIS PATIENTS

Objective: To investigate the relationship between nutritional status and body fluid distribution in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods: Sixty-six CAPD patients without edema were recruited in this study. Patients’ fluid status was measured by bioimpedance analysis (BIA) and nutritional status was assessed by subjective global assessment (SGA). Thirty-six age-matched healthy people served as controls. Results: As compared to the healthy control, CAPD patients had significant abnormal fluid distribution in the body with significantly decreased intracellular water (ICW) and little change in extracellular water (ECW). Malnutrition further aggregated the changes in body fluid distribution. Conclusion: Body fluid distribution is abnormal in CAPD patients and may be affected by patients’ nutritional status. The ratio of ICW/ECW can not be correctly used to evaluate hydration state when the patient is malnourished. Key word: intracellular water (ICW); extracellular water (ECW); bioimpedance analysis (BIA); malnutrition