在线尿素清除率监测对血液透析充分性评价的研究

Clinical research of hemodialysis adequacy evaluation using on-line clearance monitoring

目的探讨在线尿素清除率监测对血液透析充分性的评估价值。方法选取规律血液透析患者65例,其中男38例,女27例,平均透析时间(41±29)个月。透析中血流量200～300ml/min,透析液流量500ml/min,利用在线尿素清除率监测(on-line clearance monitoring,OCM)Kt/V值;同时透析前后取全血检测尿素氮浓度等,根据单室尿素动力模型DaugirdasⅡ公式计算Kt/V值,比较2种方法的相关性及不同体质量,超滤量,血流量,血红蛋白,红细胞压积对两者的影响。结果本组65例患者利用OCM法测得的Kt/V值与采血计算法所得的Kt/V值分别为(1.42±0.25)与(1.45±0.25),直线回归分析相关指数r=0.979,P<0.001。不同体质量≤60kg和>60kg的2组患者,OCM监测的Kt/V值分别为(1.50±0.27)与(1.37±0.22),t=2.09p=0.04采血计算Kt/V值(1.54±0.27)与(1.40±0.22),t=2.23,P=0.032者有显著差别。不同超滤量<3kg和≥3kg的2组患者,Kt/V值无显著差别OCM法比较t=-1.34,P=0.19采血计算法比较t=-1.52,P=0.13。不同血流量200～250ml/min和260～300ml/min的2组患者,Kt/V值有显著差别OCM法比较t=-9.11p=0.01采血计算法比较t=-9.13,P=0.01。不同血红蛋白水平Hgb≤110g及Hgb>110g的2组患者,Kt/V值无显著差异OCM法比较t=0.33,P=0.74采血计算法比较t=-0.15,P=0.88。不同红细胞压积水平HCT≤33%及HCT>33%的2组患者,Kt/V值无显著差异OCM法比较t=-0.50,P=0.62采血计算法比较t=-0.81,P=0.43。结论采用OCM监测可以很好的反映患者单次透析的尿素清除,有利于短期内调整透析处方,并结合其结果制定个体化的透析方案,以保证患者的透析充分性。

Objective To evaluate hemodialysis adequacy by on-line clearance monitoring （OCM）.Methods Sixty-five maintenance hemodialysis patients were investigated by using OCM appliance.Their average hemodialysis duration was 41±29 months,blood flow for dialysis was 200-300ml/min,and dialysate flow was 500ml/min.Meanwhile,blood urea nitrogen （BUN） in pre- and post-dialysis periods was examined to calculate Kt/V based on the equation of Daugirdas Ⅱ.We then evaluated the correlation between the two methods.Kt/ V from OCM and from calculation were also compared in the situations of different body weight,ultrafiltration volume,blood flow,hemoglobin and hematocrit.Results Kt/V value by OCM and by calculation was 1.42±0.25 and 1.45±0.25,respectively,and the correlation coefficient was 0.979 （P 0.001） by linear regression analysis.In group A （body weight ≤ 60kg） and group B （body weight 60kg）,the Kt/V value from OCM was 1.50±0.27 and 1.37±0.22 （P=0.04）,respectively,and the value by calculation was 1.54±0.27 and 1.40±0.22 （P=0.03）,respectively.The Kt/V differences either by OCM or by calculation were statistically insignificant between the patients with ultrafiltration volume3kg and those with the volume ≥ 3kg,but was significant between the patients with dialysis blood flow 200-250ml/min and those with the flow 260-300ml/min.The Kt/V differences either by OCM or by calculation were statistically insignificant between the patients with hemoglobin ≤ 110g and those with hemoglobin 110g,and between the patients with hematocrit ≤ 33 and those with hematocrit 33.Conclusion OCM can accurately reflect Kt/V data.Therefore,it is a useful method for doctors to monitor dialysis adequacy and to adjust dialysis prescription quickly for adequate hemodialysis.