探索应用节段生物电阻抗法评价血液透析患者容量状况  

Application of modified segmental bioimpedance spectroscopy for estimation of volume status in hemodialysis patients

作　　者：刘婧[1] 周亦伦[1] 孙芳[1] 马丽洁[1] 沈洋[1] 韩彬[1] 刘文虎[2] 崔太根[1] 

机构地区：[1]首都医科大学附属北京朝阳医院,北京100020 [2]首都医科大学附属北京友谊医院肾内科,北京100050

出　　处：《中国血液净化》2010年第2期84-87,共4页Chinese Journal of Blood Purification

摘　　要：目的探索应用改良的节段生物电阻抗法-小腿电阻抗比值(CBIR)评估血液透析(HD)患者的容量状况。方法使用多频生物电阻抗分析仪测定157例健康志愿者右侧小腿的电阻抗值,计算CBIR(impedance 200k/impedance 5k)作为容量负荷指标,并确定正常参考值范围。同时检测117例HD患者透析后CBIR,观察患者容量负荷状况。结果健康志愿者的CBIR为(0.774±0.028),由此确定正常参考值范围为0.746～0.802(均数±1个标准差)。HD组透析后CBIR明显高于正常对照组[(0.790±0.033)vs(0.774±0.028),P<0.001],其中容量增高者(CBIR>0.802)、容量正常者(CBIR在0.746～0.802)和容量降低者(CBIR<0.746)分别占36.8%,53.0%,10.2%。在使用降压药的剂量无显著差异的情况下,CBIR增高组高血压的发生率明显高于CBIR正常组(P=0.008)和CBIR降低组(P=0.003)。结论小腿电阻抗检测可能是评估HD患者容量状况的有效方法。Objective To evaluate volume status in hemodialysis （HD） patients by modified bioimpedance spectroscopy - calfbioimpedance ratio （CBIR）. Methods Calfbioimpedance was measured by bioimpedance spectroscopy. As an index of volume status, CBIR was calculated as follows： CBIR = impedance of 200 kHz / impedance of 5kHz. Reference CBIR range was obtained from 157 healthy volunteers. The volume status of 117 HD patients post-dialysis was assessed using the CBIR from healthy volunteers as the reference CBIR range. Results CBIR of the healthy volunteers was 0.774 ＋ 0.028, the reference range was thus defined as 0.746-0.802 （mean ± SD）. CBIR was significantly higher in patients post-hemodialysis than in healthy volunteers （0.790 ± 0.033 vs 0.774 ±0.028, P 〈0.001）. HD patients were divided into three groups according to the CBIR： high CB1R group （〉0.802）, normal CBIR group （0.746 0.802）, and low CBIR group （〈 0.746）. There were 43 patients in high CBIR group （36.8%）, 62 patients in normal CBIR group （53.0%）, and 12 patients in low CBIR group （10.2%）. The doses of antihypertensive agents were not significantly different among the three groups. Nevertheless, hypertension was significantly higher in high CBIR group than in normal CBIR group （p=0.008） and low CBIR group （p=0.003）. Conclusions Calf bioimpedance measurement may be an effective method for the evaluation of volume status in hemodialysis patients.

关 键 词：生物电阻抗 血液透析 容量状况 

分 类 号：R318.16[医药卫生—生物医学工程]