维持性血液透析患者的透后疲乏及相关因素分析  

Analysis of post- dialysis fatigue in maintenance hemodialysis patients

作　　者：庄冰 宋宗纬[1] 骆静[1] 王红梅 方丽[1] 叶红[1] 杨俊伟[1] Zhuang Bing;Song Zongwei;Luo Jing;Wang Hongmei;Fang Li;Ye Hong;Yang Junwei.(Department of Nephrology, Second Affiliated Hospital of Nanfing Medical University, Nanjing 210003, China)

机构地区：[1]南京医科大学第二附属医院肾内科,210003

出　　处：《中华肾脏病杂志》2018年第4期249-254,共6页Chinese Journal of Nephrology

基　　金：国家自然科学基金重点项目（81530022）;江苏省社会发展项目（BE2017762）

摘　　要：目的调查维持性血液透析（maintenance hemodialysis，MHD）患者透析后疲乏感（post-dialysis fatigue，PDF）的现状，分析影响MHD患者透析后疲乏感的相关因素，提供可能有效的干预措施。方法选取南京医科大学第二附属医院血液净化中心的MHD患者120例，采用开放式的问卷调查获取临床资料，记录透析前后的相关指标，采集患者的血常规、生化及血气等结果进行统计分析。结果本研究回收有效问卷109例，超过半数的研究对象存在透析后疲乏，疲乏需要恢复的时间不同，中位数（四分位数间距）为2．0（0．0，3．0）h。本研究中，30．3％患者无明显的透析后疲乏感，35．8％患者的疲乏在透析后0．5-2．0h恢复，22．0％在透析后3—4h恢复，11．O％在透析后5—12h，0．9％需要更长时间来恢复。根据疲乏恢复时间的不同分组，3组的超滤量、超滤率、体重增长的百分比以及透后的血钠、乳酸、碳酸氢根水平、乳酸的变化差异均有统计学意义。Logistic回归分析显示，透析后疲乏恢复时间与超滤量增加（OR=2．35，95％CI 1．44-3．83）、透后的血钠降低（OR=O．75，95％C／0．65-0．88）、乳酸的升高（OR=3．16，95％CI 1．32—7．55）有关。结论MHD患者的透后疲乏感发生率高，大部分需要睡眠或休息来缓解，透析后疲乏的恢复时间与乳酸的升高密切相关，因此，乳酸可能是引起透析后疲乏的重要因素。透析过程中乳酸升高的原因值得进一步研究。Objective To analysis the post- dialysis fatigue status of maintenance hemodialysis patients, explore the influencing factors in these patients and propose effective interventions. Methods One hundred and twenty maintenance hemodialysis patients in Department of Nephrology, Second Affiliated Hospital of Nanjing Medical University were enrolled. Clinical data were obtained by questionnaires. Biochemical changes before and post hemodialysis were recorded. The serum concentrations of hemoglobin, albumin, electrolyte, bicarbonate and lactic acid were collected for analysis. Results One hundred and nine （90.8%） effective questionnaires were collected, in which more than half of patients claimed to experience post- dialysis fatigue. Time to recover from hemodialysis （TIRD） was different： the median （interquartile range） time was 2.00（0.00, 3.00） hours. In the study, 30.3% patients reported no fatigue after hemodialysis. Recovery time in 35.8% patients was more than 30 minutes to 2 hours, 22.0% was 3 to 4 hours, 11.0% was 5 to 12 hours, 0.9% patients took longer time to recover from a dialysis session. According to the recovery time, these patients were divided into three groups. Among the three groups, the ultrafiltration, the serum sodium and lactic acid after dialysis showed significant difference. It was showed by the unconditional logistic regression analysis that uhrafiltration （OR=2.35, 95%CI 1.44-3.83）, serum sodium （OR=0.75, 95%CI 0.65-0.88） , lactic acid （OR=3.16, 95%CI 1.32-7.55） were associated of TIRD. Conclusions The incidence of post-dialysis fatigue is high. Most of the patients require more rest or sleep immediately after dialysis. The level of lactic acid is a significant influencing factor of the fatigue of patients. TIRD is correlated with the elevation of lactic acid during the dialysis process, and more attention should be paid to post- dialysis fatigue.

关 键 词：肾透析 疲劳 乳酸 

分 类 号：R692.5[医药卫生—泌尿科学]