液体平衡管理对新进入维持性血液透析患者残余肾功能保护的作用  

THE EFFECTS OF FLUID BALANCE MANAGEMENT ON PRESERVING OF RESIDUAL RENAL FUNCTION IN NEW PATIENTS TREATED BY MAINTENANCE HEMODIALYSIS

作　　者：张素馨[1] 张志云[2] 

机构地区：[1]首都医科大学附属北京友谊医院肾内科,北京市100050 [2]首都医科大学附属北京地坛医院护理部

出　　处：《中国煤炭工业医学杂志》2017年第5期513-517,共5页Chinese Journal of Coal Industry Medicine

基　　金：国家自然科学基金(编号:81570660)

摘　　要：目的对新进入维持性血液透析(MHD)治疗的患者进行液体平衡管理,观察其残余肾功能(RRF)的保护情况。方法对74例新进入MHD治疗的患者进行前瞻性的液体平衡管理,随访12个月,对比随访前后患者残余尿量、透析除水量、血压控制、透析充分性、心胸比、左室重量指数(LVMI)等临床参数,记录不良事件,分析终点事件发生的相关因素;随访末分析保护RRF失败的危险因素。结果平均随访时间(10.1±2.3)月,发生终点事件10例(13.5%),RRF保护失败共计19例(25.7%),有效55例(74.3%)。与基线资料相比,随访末患者24h尿量[(1495.8±346.6)ml对(903.3±380.0)ml,P<0.001]和尿肌酐清除率明显下降[(3.92±1.34)ml/min·1.73m2对(2.33±1.10)ml/min·1.73m2,P<0.001];血压达标率升高(52.7%对71.6%,P=0.018),舒张压明显改善[(82.7±11.6)mmHg对(79.5±10.4)mmHg,P=0.039],但降压药DDD明显增高(1.82±0.29对1.96±0.53,P=0.035);患者单次透析最大除水量明显减少[(2.90±0.65)L对(2.69±0.76)L,P=0.015];心胸比[(0.50±0.04)ml对(0.48±0.04)ml,P<0.001]和LVMI[(130.1±12.0)g/m2对(117.5±12.3)g/m2,P<0.001]明显减小,差异均有统计学意义。Logistic回归显示糖尿病、随访末透析前收缩压高、随访末最大除水量是RRF保护失败的独立危险因素。结论对新进入MHD的患者开展容量控制管理可以有效保护其RRF。Objective To observe the effects of fluid balance management on preserving of residual renal function （RRF） in new patients treated by maintenance hemodialysis （MHD）. Methods The prospective nursing control of fluid balance management was used in 74 patients who initiated MHD, and they were followed up for 12 months. Clinical parameters were detected and compared between baseline and the end of following up, which including 24 hours urine volume and clearance of creatinine （CCr） , fluid removed during one session of hemodialysis （HD） treatment, blood pressure, KT/V, cardiothoracic ratio （CTR）, and ventricular mass index （LVMI）. Endpoint events were recorded, and the risk factors of preserving RRF failure were analyzed. Results The mean period of following up were 10. 1 ± 2.3 months. There were 10 cases （13. 5%）of endpoint events, 19 cases（E5. 7%） preserving RRF failure. There were significant differences between baseline and the end of following up on parameters of 24h urine volume（ 1495.8 ± 346.6 ml vs. 903.3 ± 380.0ml,P〈0. 001）, CCr（3.92 ± 1.34ml/min·1.73m^2 vs. 2.33 ± 1.10ml/min · 1.73m^2 , P〈0. 001 ）, diastolic blood pressure（82.7 ±11.6mmHg 对79.5 ± 10.4mmHg, P = 0. 039）, defined daily dose （DDD） of antihypertensive medicine（1.82 ± 0.29对 1.96 ± 0.53 ,P = 0. 035）, the maximum fluid removal volume in one HD session （2.90 ＋ 0.65L vs. 2.69 ± 0.76L,P = 0. 015）, CTR（0.50 ±0.04 vs. 0.48 ± 0.04ml, P〈0. 001 ）, and LVMI（ 130.1± 12.0 g/m^2 vs. 117.5 ± 12.3g/m^2 , P〈0. 001 ）. The independent risk factors included diabetes mellitus, increased systolic blood pressure and the maximum fluid removal volume at the end of following up. Conclusion Fluid balance management is benefit to preserve RRF in new MHD patients.

关 键 词：液体平衡 血液透析 残余肾功能 高血压 健康管理 

分 类 号：R459.5[医药卫生—治疗学]