血流量和透析液流量对血液透析充分性的影响  

The effect of increasing blood flow rate and dialysate flow rate on dialysis adequacy in maintenance hemodialysis patients

作　　者：侯国存[1] 孙秀丽[1] 殷娜[1] 冯国徵[1] 闫海霞[1] Hou Guocun;Sun Xiuli;Yin Na(Blood Purification Center,Central Hospital of Baotou City,Baotou 014040,China)

机构地区：[1]包头市中心医院血液透析中心,内蒙古包头014040

出　　处：《国际泌尿系统杂志》2018年第6期1000-1003,共4页International Journal of Urology and Nephrology

摘　　要：目的 前瞻性单中心观察增加血流量（blood flow rate,Qb）从250 mL/min到300mL/min和增加透析液流量（dialysate flow rate,Qd）从500 mL/min到800 mL/min对维持性血液透析患者（maintenance hemodialysis,MHD）透析充分性的影响.方法 选择稳定透析3个月以上的MHD患者54例.观察随访共4周.第1周与第2周,透析泵控血流量固定于250 mL/min,透析液流量分别定于500 mL/min和800 mL/min各一周;第3周与第4周,透析泵控血液流量均固定为300 mL/min,透析液流量分别定于500 mL/min和800 mL/min各一周.本研究期间,透析时间均预设为4h,透析器均为费森公司空心纤维血液透析器FX10,脱水量根据患者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.同时,于每周第三次血液透析时抽全血分别测定透析前后测血尿素氮水平,记录每次透析的有效血流量、透析时间、超滤量及透析后体重,并根据Kt/V的自然对数公式计算Kt/Vsp.采用配对资料t检验和方差分析进行统计学分析.结果 本研究共纳入54例MHD患者,因研究过程中出现病情波动剔除8例,余患者数据完整,并进行统计分析.其中男性30例,女性16例,平均年龄（52.78±11.12）岁,HD平均治疗1057 d.每例MHD患者构成自身对照,研究前后一般情况一致,每周平均超滤量比较无统计学差异.第3周、第4周的有效血流量（270.01±4.35） mL/min、（270.32±3.95）mL/min与第1周、第2周的有效血流量（230.08±3.62） mL/min、（230.30±3.07） mL/min比较,明显提高,差异有统计学意义（P＜0.05）.第2、3、4周时,Kt/Vsp值均较第1周时增加,差异有统计学意义（P＜0.05）,Kt/Vsp值均较第1周时分别提高4％、8％和12％.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2.22L,超纯水多消耗72.76 L,每人每年则多消耗A液346.32 L,多消耗超纯水11350.56 L.结论 增加Qb提高MHD患者透析充分性的效率明显高于�Objective A few publications show that increasing dialysate flow rate （Qd） no longer lead to an increase in Kt/V measurement with using high-flux membrane dialyzers.The aim of this study is to assess the effect of increasing dialysis flow rate or blood flow rate（Qb） during hemodialysis with low-flux membrane dialyzer on the adequacy of dialysis.Methods In this study,54 patients with maintenance HD were assessed.All patients were dialysed with conventional bicarbonate heamodialysis and three sessions per week with each Qb（250 mL/min or 500 mL/min） and Qd （500 mL/min or 800 mL/min） were performed.Delivered dose of dialysis,measured by Kt/Vsp,was assessed during last dialysis session per week.Kt/Vsp was calculated according to the equations by Daugirdas.Blood samples were drawn immediately predialysis and postdialysis from the arterial of the access.HD parameters were acquired directly from the monitor display：effective blood flow rate,Qd,ultrafiltration volume and dialysis time.Results A total number of 46 patients including 30 males and 16 females were studied.The mean age of the studied population was （52.78 ± 11.12） years and the mean dialysis duration was 1057 days.There was no statistical difference in ultrafiltration volumes per week.The relative gains in Kt/Vsp for increasing Qb from 250 to 300 mL/min and Qd from 500 to 800 mL/min was 8％ and 4％,respectively.When Qd was 800 mL/min,we spent 2.2 L of acid concentrate and 72.76 L of water more than when Qd was 500 mL/min in only one patient per HD session.Conclusions Increasing Qb from 250 to 300 mL/min is associated with a more efficient increase in Kt/Vsp than increasing Qd and also less water consumption.

关 键 词：肾透析 肾血流量 有效 透析液 

分 类 号：R692.5[医药卫生—泌尿科学]