维持性血液透析患者最佳透析液碳酸氢盐浓度的研究进展  

Advances in research on optimal dialysate bicarbonate concentration for maintenance hemodialysis patients

作　　者：万静芳 陈客宏 WAN Jingfang;CHEN Kehong(Department of Nephrology,Daping Hospital,Army Medical University,Chongqing 400042,China)

机构地区：[1]陆军军医大学大坪医院肾内科,重庆400042

出　　处：《实用医学杂志》2024年第18期2520-2524,共5页The Journal of Practical Medicine

基　　金：重庆市自然科学基金项目(编号:CSTB2023NSCQMSX0584)。

摘　　要：代谢性酸中毒是维持性血液透析(maintenance hemodialysis,MHD)患者最常见的并发症之一。MHD患者酸碱平衡的维持主要取决于透析液中补给的碱总量。理想的透析液碳酸氢盐(dialysate bicarbonate,DBIC)浓度是既要防止下次血液透析前的代谢性酸中毒,又避免此次透析后的代谢性碱中毒。透析前代谢性酸中毒纠正不足或过度都与患者不良预后相关,但目前尚缺乏最佳DBIC浓度推荐的指南或专家共识。该文针对MHD患者DBIC浓度与酸碱紊乱的关系,DBIC与患者预后及最佳DBIC浓度研究进行综述,为制定科学、个体化的DBIC透析处方提供参考依据。Metabolic acidosis is a prevalent complication in patients undergoing maintenance hemodialysis(MHD).The maintenance of acid-base balance in MHD patients primarily relies on the total alkali supply in the dialysate.Achieving an optimal concentration of dialysate bicarbonate(DBIC)is crucial to prevent metabolic acidosis before subsequent hemodialysis sessions while avoiding metabolic alkalosis after the current session.Inad⁃equate correction or overcorrection of pre-dialysis metabolic acidosis has been associated with unfavorable patient outcomes;however,there is currently a lack of guidelines or expert consensus regarding DBIC concentration.This study addresses the epidemiology of metabolic acidosis in MHD patients,explores the relationship between DBIC concentration and acid-base disorders,and discusses recent advancements in determining the ideal DBIC concentration,providing valuable insights for formulating scientifically sound and personalized DBIC dialysis prescriptions.

关 键 词：维持性血液透析 透析液碳酸氢盐浓度 人工智能 代谢性酸中毒 代谢性碱中毒 

分 类 号：R459.5[医药卫生—治疗学]