浮肿指数评估腹膜透析患者容量负荷的临床价值  

The clinical value of edema index in assessing the volume load of peritoneal dialysis patients

作　　者：竺奇凡 陈洪宇[1] 王华[1] Zhu Qifan

机构地区：[1]浙江中医药大学附属杭州市中医院,310007

出　　处：《浙江临床医学》2022年第4期528-531,共4页Zhejiang Clinical Medical Journal

基　　金：浙江省中医药科技计划项目(2018ZB090)。

摘　　要：目的探讨浮肿指数(ECW/TBW)评估腹膜透析(PD)患者容量负荷的临床价值。方法选取2018年7月至2020年10月在杭州市中医院行标准持续性非卧床腹膜透析(CAPD)治疗>3个月的PD患者57例作为研究对象,使用多频生物电阻抗法(MBIA)测量患者的ECW/TBW值,收集患者的一般资料以及血生化、电解质、心脏超声等检查指标,根据是否存在显性水肿分组,统计PD患者ECW/TBW达标情况,并将ECW/TBW与各项观察指标进行相关性分析,寻找ECW/TBW的独立影响因素,评估ECW/TBW诊断容量超负荷的效能。结果相关性分析显示,ECW/TBW与血钠水平、左心室舒张末期内径(LVIDd)呈正相关(P<0.01),与白蛋白(Alb)、血红蛋白(Hb)水平呈负相关(P<0.05)。Alb、LVIDd和Hb是PD患者ECW/TBW的独立影响因素。显性水肿组PD患者的ECW/TBW值较无显性水肿组明显升高,心脏射血分数(EF)、Hb较无显性水肿组更低,差异均有统计学意义(P均<0.05)。ECW/TBW诊断显性水肿的ROC曲线下面积为0.693。结论ECW/TBW与PD患者的Alb、Hb、LVIDd具有一定相关性,对容量超负荷所导致的心力衰竭和心脏器质性改变具有预警作用。Objective To explore the clinical value of using the edema index(ECW/TBW)to assess the volume load of peritoneal dialysis(PD)patients.Methods 57 PD patients who underwent standard continuous ambulatory peritoneal dialysis(CAPD)for more than 3 months in Hangzhou Hospital of TCM from July 2018 to October 2020 were selected as the research objects.The ECW/TBW values of patients were measured by multifrequency bioelectrical impedance(MBIA),and the general data,blood biochemistry,electrolyte,cardiac ultrasound and other examination indexes were collected.They were grouped according to the presence of dominant edema,the compliance of ECW/TBW in PD patients was counted,and the correlation between ECW/TBW and various observation indexes was analyzed to find the independent influencing factors of ECW/TBW and evaluate the efficiency of ECW/TBW in diagnosing capacity overload.Results Correlation analysis showed that ECW/TBW was positively correlated with blood sodium level and left ventricular end diastolic diameter(LVIDd)(P<0.01),and negatively correlated with albumin(Alb)and hemoglobin(Hb)(P<0.05).Alb,LVIDd and Hb were independent influencing factors of ECW/TBW in PD patients.The ECW/TBW value of PD patients in the dominant edema group was significantly higher than that in the non-dominant edema group,and the cardiac ejection fraction(EF)and Hb were lower than those in the non-dominant edema group(all P<0.05).The area under the ROC curve of ECW/TBW in the diagnosis of dominant edema was 0.693.Conclusion ECW/TBW has a certain correlation with Alb,Hb and LVIDd in PD patients,and has an early warning effect on heart failure and cardiac organic changes caused by volume overload.

关 键 词：浮肿指数 腹膜透析 容量状态 电阻抗 

分 类 号：R47[医药卫生—护理学]