透析液水质对维持性血液透析患者睡眠质量的影响

Clinical Observation of Dialysate Quality on Sleep Quality of Patients with Maintenance Hemodialysis

目的探讨提升透析液水质对长期血液透析患者睡眠质量的改善作用。方法以46例维持性血液透析(maintenance hemodialysis,MHD)患者为研究对象。记录患者一般临床资料和常用血生化指标;采用匹茨堡睡眠质量指数量表(Pittsburgh sleep quality index,PSQI)评定MHD患者睡眠质量。比较水处理系统升级前后患者睡眠状况变化并分析其影响因素。结果与水处理系统升级前比较,MHD患者PSQI总分(7.86±3.41)vs.(9.11±2.47)呈显著下降(P<0.01);主观睡眠质量得分<1分者67.4%vs.41.3%,显著提升(P<0.05)。水质升级后,随时间延长,血清白蛋白和体质量矫正的标准化蛋白分解率(normalized protein catabolic rate,nPCR)显著增加并持续稳定,血C反应蛋白(C-re-active protein,CRP)显著下降;睡眠质量因子得分与血CRP呈显著正相关(r=0.601,P<0.01),与白蛋白和nPCR呈显著负相关(r=-0.432、-0.417,P<0.01)。结论透析液水质提升能够明显改善MHD患者的睡眠质量,其改善作用可能与营养状况好转和微炎症状态逆转有关。

Objective To explore the effect of upgrade of dialysate quality on the sleep quality of patients with maintenance hemodialysis（MHD）. Methods Forty-six MHD patients were enrolled in the study.Their clinical data and serum parameters were recorded,and the sleep quality was evaluated by Pittsburgh sleep quality index（PSQI） during the observation period.The changes of sleep state and influencing factors were assessed before and after the upgrade of dialysate quality. Results After the upgrade of water management system,the PSQI score of MHD patients decreased obviously（7.86±3.41 vs.9.11±2.47, P0.01）,and the ratio of patients with ≤1 score of subjective sleep quality（67.4% vs.41.3%）,sleep confuse（65.2% vs.39.1%） and day sleep confuse（54.3% vs.30.4%） increased significantly（P0.05）.As time extended,the levels of serum albumin and protein catabolic rate（PCR） were improved obviously,and the level of C-reactive protein（CRP） was decreased significantly.PSQI score was positively correlated with CRP（r=0.601,P0.01）,and negatively correlated with albumin and PCR（r=-0.432,-0.417,P0.01）. Conclusion The promotion of dialysate quality by upgrading water management system can obviously improve the sleep quality of MHD patients,which may relate with the nutrition improvement and microinflammation state amelioration.