尿素清除率K 作为影响血液透析患者透析充分性重要指标的临床研究  

Clinical study of urea clearance K as an important index affecting the adequacy of dialysis in hemodialysispatients

作　　者：张洪利[1] 朱强[1] 廖永平 田冲 高宁 ZHANG Hong-li;ZHU Qiang;LIAO Yong-ping;TIAN Chong;GAO Ning(Department of Nephrology and Rheumatology Immunology,Huabei Petroleum Administration Bureau General Hospital,Ren qiu 062550,China)

机构地区：[1]华北石油管理局总医院肾病与风湿免疫科,任丘062550

出　　处：《中国血液净化》2023年第10期744-748,共5页Chinese Journal of Blood Purification

摘　　要：目的通过联机清除率监测(online clearance monitoring,OCM)实时动态监测,探讨透析过程中尿素清除率(urea clearance,K)的变化规律、影响因素及与透析充分性之间的量化关系。方法应用OCM观察152例血液透析患者透析中不同时段的K值,采用重复测量方差分析探究透析过程中K变化规律;采用多元线性回归分析平均K值的影响因素;采用Pearson进行相关性分析。结果K随时间变化呈线性下降(F=447.552,P<0.001)。血流量(β=0.706,95%CI:0.403~0.526,P<0.001)、超滤系数(β=0.183,95%CI:0.074~0.223,P<0.001)与K呈正相关,红细胞比容(HCT)(β=-0.242,95%CI:-0.877~-0.405,P<0.001)、年龄(β=-0.106,95%CI:-0.209~-0.011,P=0.030)与K呈负相关。K与3倍干体质量的差值和Kt/V之间存在显著相关性(r=0.808,P<0.001)。结论透析过程中K呈线性缓慢下降。提高K的手段是增加血流量、使用高通量透析器,控制HCT在33%~36%。若透析充分性达标,K应大于干体质量的3倍。Objective Through online clearance monitoring(OCM),the quantitative relationship among the changes of urea clearance(K),its influencing factors and dialysis adequacy during dialysis processes are discussed.Methods A total of 152 maintenance hemodialysis patients were investigated.The K value during a hemodialysis session was recorded by OCM every hour.ANOVA of repeated measurements was used to explore the rule of K change during hemodialysis.Multivariate linear regression was used to explore the influencing factors for average K value.Results The K value decreased linearly with time during a hemodialysis session(F=447.552,P<0.001).The K value was positively correlated with blood flow rate(BFR)(β=0.706,95%CI:0.403~0.526,P<0.001)and ultrafiltrate coefficient(β=0.183,95%CI:0.074~0.223,P<0.001),and was negatively correlated with haematocrit(HCT)(β=-0.242,95%CI:-0.877~-0.405,P<0.001)and age(β=-0.106,95%CI:-0.209~-0.011,P=0.030).We also found that there was a significant correlation between the difference of K value and three times of dry body weight and the dialysis adequacy of Kt/V(Pearson correlation analysis,r=0.808,P<0.001).Conclusion The K value decreases linearly and slowly during a hemodialysis session.The ways to increase K value include the increase of BFR,the use of high-flux dialyzer,and the maintenance of HCT within 33~36%.We infer that the K value should be more than three times of the dry body weight to obtain a standard level of dialysis adequacy.

关 键 词：尿素清除率 透析充分性 联机清除率监测 透析时间 干体质量 

分 类 号：R459.35[医药卫生—治疗学]