单中心维持性血液透析充分性的评价  

Maintenance hemodialysis adequacy evaluation using online clearance monitoring in a hemodialysis center in Lanzhou

作　　者：席春生[1] 张英[1] 方春天 刘冬梅[1] 刘同存[1] 张萌[1] 关怀[1] 高健[1] 李亚妹[1] 

机构地区：[1]兰州军区兰州总医院肾脏病内科

出　　处：《临床肾脏病杂志》2015年第4期226-229,共4页Journal Of Clinical Nephrology

基　　金：兰州军区医药卫生科研基金资助项目(NO.CLZ11JB01)

摘　　要：目的评估分析兰州军区兰州总医院血液净化中心维持性血液透析患者血液透析充分性的情况，为进一步规范化制定血液透析处方和评估血液透析质量提供依据，进而提高维持性血液透析患者的生活质量。方法采用单中心横断面调查的对照研究方法，应用在线尿素清除率监测（on-line clearance monitoring，OCM）尿素清除指数（Kt／V），统计分析2014年5月～6月我院血液净化中心维持性血液透析患者211例的人口统计学资料、血液透析处方、超滤量、血流量，以测定的单次Kt／V值≥1．2为透析达到充分性的标准，并对Kt／V值达到和未达到充分性的2组患者临床资料进行对比分析。结果①211例维持性血液透析患者单次Kt／V值为0．65～1．88，平均Kt／V值为（1．11±0．20）；其中74例患者（占35．oH）单次Kt／V值≥1．2；137例患者（占65．0%）单次Kt／V值〈1．2，146例患者（146／211，占69．1％）单次Kt／V值≥1．0。②对Kt／V值达到和未达到充分性的2组患者临床资料进行对比分析发现，2组患者的男女比例[（30／44）比（122／15）]及体质量[（56．0±10．1）kg比（68．8±12．3）kg]均有统计学差异（P〈0．05），而超滤量[（2．62±0．69）L比（2．74±1．02）L]及血流量[（234．8±21．4）ml／min比（232．4±30．4）ml／min]则无统计学差异（P〉0．05）。结论①OCM用于维持性血液透析的充分性监测方便、快速；②本中心维持性血液透析患者的血液透析充分性总体达标率低，需综合评估，个体化处方，加强患者管理；③男性、体质量较高的患者达标率低，需重视此类患者的透析充分性评估，并进一步调整血液透析处方。Objective To evaluate the hemodialysis adequacy of hemodialysis patients by online clearance monitoring （OCM） in Hemodialysis Center of Lanzhou General Hospital in order to monitor dialysis adequacy and adiust dialysis prescription quickly for adequate hemodialysis. Methods 211 maintenance hemodialysis patients in this center in 2014 were included, and hemodialysis adequacy was investigated using OCM appliance. The average hemodialysis duration, blood flow and ultrafihration volume were recorded. Kt/V from OCM was also compared in the situations of different body weight, uhrafiltration volume and blood flow between Kt/V≥ 1.2 group and Kt/V〈 1.2 group. SPSS software was used for the statistical analyses. Results （1） Kt/v value of maintenance hemodialysis patients was 0. 65-1.88 and mean Kt/V value was （1.11 ± 0. 20） in this study. There were 74 patients （35%） with Kt/V≥1. 2, 137 patients （65%） with Kt/V〈1. 2 and 137 patients （69. 1%） with Kt/V ≥1.0. （2） There was significant difference in male/female ratio （30/44 vs. 122/15） and body weight （56. 0 ± 10. 1 ）kg vs. （68. 8± 12. 3）kg between Kt/V≥1. 2 group and Kt/V〈1. 2 group （P〈0. 05）. There was no significant difference in blood flow [（234. 8 ± 21.4）ml/min vs. （232. 4±30. 4）ml/min] and uhrafihration volume （2. 62 ＋ 0. 69）L vs. （2. 74 ± 1.02}L between Kt/V≥1. 2 group and Kt/V〈 1.2 group （P〉0. 05）. Conclusions （1） OCM was a simple and rapid method for doctors to monitor dialysis adequacy and adjust dialysis prescription for adequate hemodialysis; （2） In this center, the adequacy of patients with maintenance hemodialysis was relatively lower, and it is urgent to adjust the dialysis prescription comprehensively and individually. （3） The hemodialysis adequacy of male patients and heavy body weight patients was lower. We should pay attention to monitor hemodialysis adequacy of these two populations and adjust prescription.

关 键 词：血液透析 透析充分性 在线尿素清除率监测 病例对照研究 

分 类 号：R459.5[医药卫生—治疗学]