维持性血液透析患者容量负荷与营养状态的关系  

Relationship between volume status and nutritional status in maintenance hemodialysis patients

作　　者：李洋[1,2] 唐利军[2] 崔美玉[2] 关广聚[3] 王尊松[2] 

机构地区：[1]潍坊医学院,潍坊261000 [2]山东大学附属千佛山医院肾内科,济南250014 [3]山东大学第二医院肾内科,济南250033

出　　处：《临床肾脏病杂志》2016年第4期206-209,共4页Journal Of Clinical Nephrology

基　　金：山东省自然科学基金科研课题(NO.ZR2010HL012);山东省科技发展计划(NO.2012YD18079)

摘　　要：目的探讨维持性血液透析患者容量负荷与营养状态的关系。方法通过超声测量下腔静脉直径(inferior vena cava diameter,IVCD)评价容量负荷状态,以超过健康志愿者下腔静脉内径P95且下腔静脉塌陷指数<40%定为容量超负荷,将120例尿毒症维持性血液透析患者根据以上标准分为容量正常组(normal volume,NV组,33例)和容量超负荷组(overloaded volume,OV组,87例),采用改良的主观整体综合评价法(Modified Quantitative Subjective Global Assessment,MQSGA)评分量表评价患者的营养状况,比较两组患者营养状况,并应用一元线性回归分析评价容量负荷与MQSG.A的关系。结果OV组与NV组相比,OV组重度营养不良发生率明显升高[OV组72.41%(63/87),NV组0%],差异有统计学意义(P<0.01);而轻度营养不良发生率较低[0v组5.75%(5/87),NV组51.52%(17/33)]、中度营养不良发生率也较低[OV组21.84%(19/87),NV组48.48%(16/33)],两组比较差异均有统计学意义(均P<0.01)。NV组患者MQSGA为(13.64±3.19)分,OV组患者MQ!SGA为(24.37±5.04)分,两组比较,差异有统计学意义(P<0.05)。回归分析显示,MQSGA与容量负荷呈直线回归关系(回归系数b=2.466,P<0.01)。结论维持性血液透析患者营养状态与容量负荷相关,容量超负荷组严重营养不良的发生率明显增加,随着容量负荷增加,营养状况更差。改善容量超负荷有利于纠正患者营养不良。Objective To evaluate the relationship between volume status and nutritional status in maintenance hemodialysis patients. Methods Inferior vena cava diameter （IVCD） was measured u- sing M-mode ultrasonic diagnostic equipment to assess the fluid status, overloaded volume status was defined as IVCD exceeding the 95 percentile of healthy volunteers＇ and collapsibility index less than 40%. 120 uremic patients undergoing hemodialysis were divided into two groups： normal volume group （NV） and overloaded volume group （OV）. Modified quantitative suhjective global assessment （MQSGA） was used to evaluate nutritional status. Linear regression was used to analyze the relation- ship between volume status and nutritional status. Results The rate of severe malnutrition was signifi- cantly higher in OV group than that in NV group, while the rate of mild and moderate malnutrition was significantly lower in OV group [（72. 41% vs. 0） and （5. 75% vs. 51.52%） and （21.84% vs. 48. 48%） separately, P〈0. 011. There was significant difference in MQSGA between NV group and OV group [（13. 64 ± 3.19） vs. （24. 37 ± 5.04）, P〈0. 051. Linear regression was found between nutritional status and volume status, b = 2. 466, P〈0. 01. Conclusions Nutritional status is associated with volume status in maintenance hemodialysis patients. With the volume overloaded, severe malnu- trition become more frequent. The patients with overloaded volume usually were in poor nutritional status. To improve the capacity of overload in patients with malnutrition is recommended.

关 键 词：血液透析 容量负荷 营养状态 

分 类 号：R692.5[医药卫生—泌尿科学]