不同HCO3^-浓度透析液对透析患者酸碱平衡和营养状态的影响

Effects of different bicarbonate dialysate on acid-base balance and nutritional status in hemodialysis patients

目的旨在分析不同HCO3^-浓度透析液对机体酸碱平衡以及营养状态的影响。方法24例稳定的维持性血液透析患者参与试验，使用单盲、交叉对照分析，共3个月试验周期，参试患者分别接受低HCO3^-浓度透析液（30．0mmol／L）（甲组）和高HCO3^-浓度透析液（40．0mmol/L）（乙组）透析，记录并分析人体生物学指标、生化指标和透析剂量以及透析充分性指标。结果试验开始时甲、乙组血清总CO2结合力分别为（22．0±2．6）mmol/L、（22．54±-3．2）mmol／L，两组比较差异无统计学意义；但乙组3个月后血清总CO2结合力增高到（25．5±1．8）mmol/L，与试验开始时比较差异有统计学意义；甲组无显著性变化。Kt／V（乙组1．29±0．21、甲组1．28±0．15），标准化蛋白代谢率（nPCR）[乙组（1．15±0．16）g／（kg·d）、甲组（1．25±0．18）g／（kg·d）]差异均无统计学意义。三角肌皮褶厚度（TSF）有显著性变化[甲组由试验开始时（14．8±1．6）mm，至3个月后（12．6±1．1）mm，乙组为（14．5±2．3）至（16．5±1．5）mm，P〈0．0530结论高HCO3^-浓度透析液对透析患者是相对安全的，患者均能较好耐受，且能较好地纠正机体酸中毒状态，与低HCO3^-浓度透析液相比，能提高患者TSF，提示患者营养状态改善。

Objective To investigate the effects of different bicarbonate dialysate on acid-base balance and nutritional status. Methods Twenty-four stable hemodialysis patients were dialysed using bicarbonate dialysate 30.0 mmol/L（group A） or 40.0 mmol/L（group B） in blind crossover trial, of 3-month periods. Anthropometric index,biochemical index,dialysis dose and sufficience index were measured. Results Combination rate of plasma total CO, was no difference between two groups [ （group A was （22.0 ± 2.6） mmol/L,group B was （22.5 ± 3.2）mmol/L] ,while 3 months later dialysis plasma total CO2 showed a significant change in group B [ （22.5 ± 3.2）mmol/L to （25.5 ± 1.8）mmol/L, P 〈 0.05 ]. Kt/V was 1.28 ± 0.15 in group A, 1.29 ± 0.21 in group B,nurmalized protein catabolic rate（nPCR） was（ 1.25 ± 0.18）g/（kg·＂d） and （ 1.15 ± 0.16） g/（kg·d） in two groups,there were no significant difference. Triceps skinfold thickness （TSF） was（ 14.8 ± 1.6）-（ 12.6 ± 1.1 ）mm in group A, （14.5 ± 2.3）-（16.5 ± 1.5） mm in group B,there was a significant change （P 〈 0.05）. Conclusions Bicarbonate dialysate concentration of 40 mmol/L is safe,well tolerated, and produces better control of acidosis, with an increase in TSF, compared to a bicarbonate concentration of 30 mmol/L.