应用无创血流动力学监测评估血液透析容量状况研究

The application of noninvasive hemodynamic monitoring for evaluation of volume status in patients undergoing hemodialysis

目的应用无创血流动力学监测评估维持性血液透析(MHD)患者的容量状况。方法选择2011年8月至2012年1月河北医科大学第四医院血液净化中心行MHD治疗的患者42例,同时收集健康志愿者200名。应用BioZ.com无创血流动力学监测仪测量200名健康志愿者及42例MHD患者的胸液含量(TFC),观察患者容量负荷状况。结果正常男性TFC高于正常女性(29.91±2.05对25.61±1.95,P<0.05)。正常参考值范围(均数±1个标准差)为男性27.86～31.96 kOhm-1,女性23.66～27.56 kOhm-1。病例组中TFC偏高亚组(男性>31.96 kO-hm-1,女性>27.56 kOhm-1)、TFC正常亚组(男性在27.86～31.96 kOhm-1之间,女性在23.66～27.56 kOhm-1之间),TFC偏低亚组(男性<27.86 kOhm-1,女性<23.66 kOhm-1)分别占28.57%、47.62%、23.81%。应用MaltronBioScan 916生物电阻抗分析仪测量MHD患者总体水占体重百分比(TBW%)。TFC偏高亚组TBW%高于正常人群(P<0.05),TFC正常亚组TBW%在正常范围内(P>0.05),TFC偏低亚组TBW%低于正常人群(P<0.05)。TFC变化量(△TFC=TFC透析后-TFC透析前)与超滤量(ultrafiltration,UF)呈负相关(r=-0.699,P<0.01),回归方程为UF=1.545-0.223×△TFC。结论应用BioZ.com无创血流动力学监测仪评估MHD患者的容量状态方法与全身生物电阻抗分析法具有良好的相关性,能够在临床判断干体重达标的基础之上进一步准确、客观地评估干体重,对干体重的调整有一定的指导意义。

Objective To evaluate the volume status in patients undergoing maintenance hemodialysis （MHD） using noninvasive hemodynamic monitoring. Methods BioZ. corn noninvasive hemodynamic monitoring system was used to measure the thoracic fluid content （TFC） in 200 healthy volunteers and 42 patients treated with MHD. The volume status of patients was then observed. Results TFC of normal males is higher than that of normal females （29. 91 ± 2. 05 vs 25. 61 ± 1.95, P 〈0. 05） ,with the normal reference range was 27.86 - 31.96 kOhm-1 in males and 23.66 - 27.56 kOhm-1 n females （mean ± SD）. The patient group was divided into high TFC subgroup （male 〉 31.96 kOhm-1 ,female 〉 27. 56 kOhm-1） ,normal TFC subgroup （ male 27.86 - 31.96 kOhm-1 , female 23.66 - 27.56 kOhm-1 ） and low TFC subgroup （ male 〈 27.86 kOhm -j ,female 〈 23.66 kOhm-l ） ,with the percentages being 28.57% ,47.62% and 23.81% ,respectively. The total body water/body weight （TBW%） was measured in MHD patients by Maltron BioScan 916 Bioimpedance. TBW% in high TFC subgroup was higher than that in healthy people （ P 〈 0.05 ）, while TBW% in low TFC subgroup was lower than that in healthy people （ P 〈 0. 05 ）. And TBW% was in the normal range （ P 〉 0.05 ）. The TFC variable （ A TFC = TFCpost -TFCpre ） was negatively correlated with ultrafiltration （UF） （r = -0. 699, P 〈 0. 01 ） and the regression equation of UF and ATFC was UF = 1. 545 -0. 223 x ATFC. Conclusion TFC can be used to evaluate the volume status in MHD patients.