透析时间对维持性血液透析患者透析充分性的影响  

The effect of dialysis time on dialysis adequacy in maintenance hemodialysis patients

作　　者：侯国存[1] 孙秀丽[1] 王慧[2] 李惠霞 郭静[1] 陈爱珍[1] 冯国徵[1] 殷娜[1] 温强[1] HOU Guocun;SUN Xiuli;WANG Hui;LI Huixia;GUO Jing;CHEN Aizhen;FENG Guozheng;YIN Na;WEN Qiang(Blood Purification Center,Baotou Central Hospital,Baotou 014040,China;Baotou Medical College)

机构地区：[1]包头市中心医院血液透析中心,内蒙古包头014040 [2]内蒙古科技大学包头医学院

出　　处：《包头医学院学报》2018年第9期16-19,共4页Journal of Baotou Medical College

基　　金：内蒙古科技大学科技百万工程联合项目[YKD2017KJBW(LH)069]

摘　　要：目的:观察增加透析时间(dialysate time)对维持性血液透析患者(MHD)透析充分性的影响。方法:随机选择稳定透析≥6个月的MHD患者16例。观察随访3周。第1周与第2周,血液透析参数设定为透析液流量(dialysate flow rate,Qd) 500 mL/min和800 mL/min各1周,透析泵控血液流量(blood flow rate,Qb)均固定300 mL/min,透析时间4 h;第3周Qd为500 mL/min,泵控Qb为300 mL/min,透析时间250 min。透析器均为费森公司FX10,脱水量根据每次体重增加情况设定,抗凝剂、促红素剂量维持不变,透析频次均为3次/周。每次透析时设定在线联机尿素清除率监测(OCM),取3次监测值的平均值作为患者该血液透析参数下OCM监测的Kt/V值(Kt/V_(ocm))。采用配对资料t检验和方差分析进行统计学分析。结果:每例患者构成自身对照,共纳入16例MHD患者,研究前后一般情况一致,每周平均超滤量比较,差异无统计学意义(P> 0. 05)。在第2周和第3周,分别将Qd由500 mL/min增加至800 mL/min与延长透析时间10 min,所得Kt/V_(ocm)值均较第1周时增加3. 9%。Qd增加至800 mL/min后,单次透析所消耗的透析A液较Qd为500 mL/min时多2. 2L,超纯水多消耗73 L。结论:将Qd从500 mL/min增加至800 mL/min,或延长透析时间10 min,均可提高患者Kt/V值,效率相当(3. 9%),提高透析液流量要以大量消耗透析A液和透析用水为代价,从可持续发展、经济和实用角度考虑,延长透析时间是提高MHD患者透析充分性的重要途径。Objective： To assess the effect of increasing dialysis time during hemodialysis on the adequacy of dialysis in maintenance hemodialysis patients（ MHD）. Methods： 16 MHD patients with stable dialysis at 6 months or more were randomly selected. The follow-up was conducted over a period of three weeks. All patients were dialysed with conventional bicarbonate heamodialysis and three sessions per week. In the first and second week,the treatment time was 4 hours,blood flow rate（ Qb） was 300 ml/min,and dialysate flow rate（ Qd） was performed at 500 mL/min and 800 mL/min,respectively. In the third week,the hemodialysis was performed at Qb of 300 ml/min and Qd of 500 ml/min,and the treatment time was 4 hours and ten minutes. The dialyzer was FX10,and the dewatering was set according to each weight gain. The dose of anticoagulant and prolan remained unchanged,and the dialysis frequency was 3 times per week. On-line clearance monitoring（ OCM） was set for each dialysis,and the average value of three monitoring values was taken as the Kt/V value（ Kt/Vocm） monitored by OCM under the hemodialysis parameters.The paired t-test and one-way ANOVA were used for statistical anlysis. Results： A total number of 16 MHD patients were studied. There was no statistical difference in ultrafiltration volumes per week for each individual before and after study（ P 〉 0. 05）. In week 2 and week 3,Qd was increased from 500 mL/min to 800 mL/min and dialysis time was extended for 10 min,and the obtained Kt/Vocm value was increased by 3. 9 %compared with that in week 1. When Qd was increased to 800 mL/min,dialysis A solution consumed by a single dialysis was 2. 2 L more than that when Qd was 500 mL/min,and ultra-pure water consumed was 73 L more than that when Qd was 500 mL/min. Conclusion： Increasing Qd from500 mL/min to 800 mL/min,or extending the dialysis time for 10 more min,Kt/V value in MHD patients all can be improved,with an equivalent efficiency（ 3. 9%）. The improvement of the dialysate flow is at the exp

关 键 词：透析液流量 维持性血液透析 透析充分性 在线联机尿素清除率监测 透析时间 

分 类 号：R692.5[医药卫生—泌尿科学]