利用尿素动力学模型评价血液透析患者总体水量  

Assessment of total body water of patients on hemodialysis with urea kinetic model

作　　者：左力[1] 王梅[1] 魏弘[1] 彭金霞[1] 冯丽丽[1] 

机构地区：[1]北京大学第一医院肾内科,北京100034

出　　处：《北京大学学报（医学版）》2004年第5期533-535,共3页Journal of Peking University:Health Sciences

摘　　要：目的 :建立一种简单实用的评价血液透析 (HD)患者总体水量 (totalbodywater,TBW)的方法 ,即以尿素动力学模型 (ureakineticmodel,UKM)为基础的评价方法 ,并与体表生物电阻抗频谱 (bio impedancespectrum ,BIS)分析法进行比较。方法 :选择稳定透析 3个月以上 ,无高分解状态的成人终末肾衰竭患者 ,透析前用BIS分析法测量TBW ,并采血测量血浆尿素浓度 ;收集和记录废透析液总量 ,测定废透析液尿素浓度 ;透析后即刻进行BIS分析 ,透析后 1h内重复BIS分析 ,同时采血测量血浆尿素浓度 ,根据UKM原理计算透析前TBW。结果 :2 4例患者入选 ,其中男 6例 ,女 18例 ,平均年龄 (5 1.2± 13.5 )岁 ,平均透析时间 (33.2± 36 .7)个月。导致终末肾衰竭的原发病包括慢性肾炎8例、糖尿病肾病 1例、高血压肾损害 1例、间质性肾炎 2例、肾盂肾炎 2例、病因不明 10例。 2 4例患者平均脱水量为 (2 .7± 1.0 )L(0 .5～ 4 .4L) ,透析前和透析后 1h血浆尿素平均值分别为 (2 3.0 6± 5 .76 )mmol/L和 (8.15± 2 .0 6 )mmol/L。在透析结束即刻和透析结束后 1hBIS分析法TBW测定结果分别为 (2 9.9± 8.8)L和 (2 9.8± 8.6 )L ,平均差值为 (0 .1± 0 .9)L ,配对差值t检验差异无显著性 (P =0 .70 ) ,两次测定的相关系数为 0 .99(P <0 .0Objective:To propose a method to evaluate the total body water (TBW) of patients on hemodialysis with urea kinetic model (UKM), and compare it with body surface bio-impedance spectrum (BIS) analysis. Methods:We enrolled 24 adult patients with end stage renal disease (ESRD) without hyper-catabolism in our dialysis center. All of them had been on hemodialysis for more than 3 months. TBW was measured with BIS analysis immediately before and after dialysis session, and one hour after hemodialysis session. Spent dialysate was collected; blood samples were taken before and one hour after hemodialysis session, TBW before hemodialysis session were calculated by UKM. Results:Patients were 6 men and 18 women, the average age was (51.2±13.5) years and the average time on dialysis was (33.2±36.7) months. Causes of ESRD included chronic glomerulonephritis (8 patients), diabetic nephropathy (1 patients), hypertensive renal damage (1 patients), interstitial nephritis(two patients), chronic pyelonephritis (two patients). The average ultrafiltration volume was (2.7±1.0) L (0.5-4.4 L) . Plasma urea concentrations were (23.06±5.76) mmol/L and (8.15±2.06) mmol/L before and one hour after hemodialysis session, respectively. There was no significant difference between TBW measured immediately after and one hour after hemodialysis session with BIS analysis [(29.9±8.8) L and (29.8±8.6) L, respectively; average difference was (0.1±0.9)L, P=0.70]. These two measurements correlated very well (Pearson r=0.99, P<0.05). There was no significant difference between UKM and BIS analysis [(31.4±7.3) L and (31.3±8.6) L, respectively; average difference was (0.2± 4.5) L, P=0.87]. Results of these two methods correlated very well (Pearson r=0.86,r 2= 0.73, P<0.05).Conclusion:TBW measured with UKM in patients on hemodialysis provides theoretic basis for fluid status evaluation and dry body weight assessment.

关 键 词：血液透析患者 透析前 尿素动力学模型 BIS 血浆 肾衰竭 透析液 分析法 高分 差值 

分 类 号：R692[医药卫生—泌尿科学] R459.5[医药卫生—外科学]