透析维持时间对长期血液透析患者透析充分性的影响  

Effects of Dialysis Maintenance Time on Dialysis Adequacy in Long-Term Hemodialysis Patients

作　　者：秦艳辉 Qin Yanhui(Tianjin Wuqing District People 55 Hospital,Tianjin 301700)

机构地区：[1]天津市武清区人民医院,天津301700

出　　处：《黑龙江医药》2020年第4期903-905,共3页Heilongjiang Medicine journal

摘　　要：目的:分析增加透析维持时间,对长期血液透析患者透析充分性的影响。方法:随机选取稳定透析≥6个月患者50例,治疗并随访3周。前两周透析时间4h,第3周增加10min,每周透析3次。每次透析时,设置在线联机尿素清除率监测(OCM),取3次OCM的均值作为Kt/Vocm。结果:纳入50例患者,第一周Kt/Vocm=1.1587±0.1036,第二周Kt/Vocm=1.2046±0.1128,第三周Kt/Vocm=1.2061±0.1129。第二周、第三周与第一周组间差异有统计学意义(t分别为2.119和2.187,P分别为0.020和P=0.017),但第三周与第二周相比差异无统计学意义(t=0.066,P=0.474)。Qd增加至800mL/min,每次透析多使用A液约29L、超纯水约950L。结论:将Qd从500mL/min增加至800mL/min,或延长透析时间10min,均可提高患者Kt/V值,两者效果相近,但提高透析液流量不利于节约水资源,而延长透析时间则是提高透析充分性的较为经济、实用的途径。Objective: To analyze the effect of increasing dialysis maintenance time on the dialysis adequacy of long-term hemodialysis patients. Methods: 50 hemodialysis patients with stable dialysis ≥6 months were randomly selected for dialysis treatment and followed up for 3 weeks. In the first week,dialysate flow Qd = 500 m L/min,pump controlled blood flow Qb = 300 m L/min,and dialysis time = 4 h. In the second week,Qd = 800 m L/min,pump controlled Qb = 300 m L/min,and dialysis time = 4 h. At week 3,Qd = 500 m L/min and pump controlled Qb = 300 m L/min,and dialysis time = 250 min. The dialyzer was Fresenius 4008-s blood dialyzer. The amount of dehydration was set according to the patient’s weight gain. The anticoagulant and erythrotropin were fixed and dialysis was performed three times a week. During each dialysis,online monitoring of urea clearance rate( OCM) was set,and the mean value of OCM for 3 times was taken as Kt/V value( Kt/Vocm) of OCM monitoring under hemodialysis parameters. Results: a total of 50 patients with hemodialysis were enrolled,and their general conditions were stable before and after the study. In the first week of dialysis,patients’ Kt/Vocm value was 1. 1587±0. 1036;in the second week,Kt/Vocm value was 1. 2046 ±0. 1128;and in the third week,Kt/Vocm value was 1. 2061 ± 0. 1129. In the second week,Kt/Vocm increased by 4. 0% compared with the first week,and the difference between groups was statistically significant( t = 2. 119,P = 0. 020). In the third week,Kt/Vocm increased by 4. 1% compared with the first week. The difference between the groups was statistically significant( t = 2. 187,P = 0. 017),but the difference between the third week and the second week was not statistically significant( t = 0. 066,P = 0. 474). After the increase of Qd to 800 mL/min,about 29 L of liquid A and about 950 L of ultra-pure water were used for each dialysis. Conclusion: increasing Qd from 500 mL/min to 800 mL/min,or prolonging dialysis time for 10 min,can improve Kt/V value of patients. The two effects ar

关 键 词：维持性血液透析 透析充分性 透析液流量 透析时间 

分 类 号：R692.5[医药卫生—泌尿科学] R459.5[医药卫生—外科学]