腹膜透析早期患者体内水的状况分析

Fluid status of CAPD patients at their early stage on dialysis

目的 通过使用生物电阻抗连续监测腹膜透析早期患者体内水负荷的状况 ,了解腹膜透析早期 ,患者体内水负荷的变化 ,探究腹膜透析患者体内水负荷过多的原因。方法 使用生物电阻抗分析仪对新近CAPD治疗半年的 36名患者体内水负荷指标进行连续测量 ,观察治疗 6个月内体重、细胞内液、细胞外液及总体水的变化 ,同时连续性监测血压 ,了解透析前、后及 6个月内的血压变化 ;通过饮食评估了解 6个月内的饮食蛋白及热卡摄入情况。结果 CAPD治疗 6个月内患者体内的水负荷呈增长趋势 ,表现为体重增加 ,细胞外液 (ECW )、细胞内液 (ICW)、总体水 (TBW)、标化后的细胞外液 (NECW)均增加 ,而腹膜的超滤量、残余尿量前后无显著性差异 ;半年内患者的饮食热卡摄入量增加 ;CAPD治疗前收缩压高于正常 ,治疗后降至正常 ,且半年内不随体内水负荷的增加发生变化。结论 腹膜透析早期 ,随着尿毒症症状的改善 ,患者体内的水负荷逐渐增加 ,早期的水负荷增加与饮食状况改善后水盐摄入相对增加有关 ;透析半年内体重明显增加应该警惕体内水负荷过多 ,不能单纯认为是营养状况的改善。早期水盐控制对腹膜透析患者具有重要的作用。

Objective To investigate the fluid status of CAPD patients by bioimpedance analysis and to study the reasons of fluid overload. Methods Thirty-six CAPD patients were included in this study. Multifrequency BIA was performed using the Xitron BIS4200 device in all patients.The body weight,extracellular water(ECW),total body water (TBW), blood pressure,urine volume and ultrafiltrate volume were measured once every month.ECW were normalized by patients’ body surface area(BSA). Results In the first 6 months on dialysis,all the parameters that relate to fluid status including body weight、ECW、normalized ECW (nECW)、TBW increased, Whereas no significant difference was found in 24h ultrafiltration、24h urine and 24h total fluid removal (P>0.05). Daily energy intake also increased significantly during the six-month follow-up. Systolic blood pressure was high before dialysis,but decreased after dialysis. Conclusion Our results suggested that fluid volume increased in most patients in the early stages of CAPD. The main reason was most probably excessive fluid and salt intake with the relief of uremia symptoms after dialysis.The increase in body weight in the early stages should not simply be considered as an improvement of nutritional status. This indicates the importance of salt and water restriction in CAPD patient even at the early stage of dialysis.