血液透析超滤脱水对细胞内外液的影响  

Does hemodialysis ultrafiltration mainly affect the extracellular fluid

作　　者：张磊[1] 李新伦[1] 高卓[1] 邱德俊[1] 刘静民[2] 郑秀瑗[2] 伦立德[1] 

机构地区：[1]解放军空军总医院肾病科,北京100142 [2]清华大学体育部,北京100084

出　　处：《临床肾脏病杂志》2016年第1期40-43,共4页Journal Of Clinical Nephrology

基　　金：首都临床特色应用科研专项基金(NO.Z111107058811085)

摘　　要：目的了解血液透析对细胞内液(intracellular water,ICW)和细胞外液(extracellular water,ECW)的影响。方法选择2012年3月1日至2014年12月31日解放军空军总医院血液净化中心行维持性血液透析(maintenance hemodialysis,MHD)治疗的患者68例,应用整体多频生物电阻抗仪测定透析前和透析后1min内的ICW和ECW,比较血液透析后ICW和ECW的减少量(△ICW和△ECW),观察透析超滤脱水对ICW和ECW变化率(ⅤICW/ICW和△ECW/ECW)的影响。结果血液透析患者68例中,男性37例(占54.41%),平均身高(1.62±0.09)m,体质量指数(bodymnas8 index,BMI)为(23.43±3.13),透析前体质量为(64.72±10.65)kg,干体质量为(61.37±10.74)kg,超滤量为(2.78士0.97)L,透析后ICW/ECW值为(1.99:1)。MHD患者透析前后,ICW从(23.34±4.53)kg下降到(21.64±4.18)kg,差异有统计学意义(t=9.518,P<0.01),ICW变化量△ICW=(1.70±1.47)kg;ECW从(12.02±2.41)kg下降到(10.91±2.20)kg,差异有统计学意义(t=10.726,P<0.01),ECW变化量△ECW=(1.11±0.85)kg,两种体液变化率分别为△ICW/ICW(7.07%±5。16%)和@ECW/ECW(9.02%±5.80%)。该研究中透析后ICW/ECW=1.99:1,与应用同位素标记的金标准测得的结果 2.0:1高度一致,优于其他多数研究中的1.11:1。结论血液透析超滤脱水同时来源于ICW和ECW变化,并非主要来源于ECW;本方法可能是最为接近金标准的方法。Objective To investigate the effects of hemodialysis on intracellular and extracellu- lar fluid space. Methods Sixty-eight stable maintenance hemodialysis （MHD） patients were selected in Air Force General Hospital of PLA from March 1, 2012 to December 31, 2014. The whole body multiple frequency bioelectrical impedance was used to measure the volume of intracellular water （ICW） and extracellular water （ECW） before and one rain after dialysis, and the volume of ICW and ECW reduction after hemodialysis treatment （AICW and/kECW）. The effect of dialysis ultrafiltration on dehydration rate of ICW and ECW （AICW/ICW and/kECW/ECW） was observed. Results The ICW was decreased from（23. 34 ± 4. 53）kg to（21.64 ±4. 18）kg （t = 9. 518, P〈0. 01） ; △ICW = （1.70 ± 1.47）kg, and ECW was decreased from （12. 02 ± 2.41） kg to （10. 91± 2. 20） kg （t = 10. 726, P〈0. 01）, △ECW= （1.11 ± 0. 85） kg before and after dialysis. The changes of two kinds of fluid rate were/kICW/ICW= （7. 07% ±5.1%） and/kECW/ECW = （9. 02%± 5.80%）. The ratio of ICW/ ECW was 1.99：1 after dialysis, which was highly consistent with the results measured by gold standard of applying isotope labeling （2.0：1） and superior to 1. 11 ：1 in most other studies. Conclusions Hemodialysis ultrafiltration volume is simultaneously derived from both intracellular and extracellular space, not mainly the extracellular space. This method is probably the most close to the gold standard method.

关 键 词：细胞内液 细胞外液 血液透析 超滤 

分 类 号：R459.5[医药卫生—治疗学]