多频生物电阻抗法评估血液透析患儿的体液分布

Estimating the body volume status in maintenance hemodialysis children with multi-frequency bioelectrical im-pedance

目的应用多频生物电阻抗法了解维持性血液透析（MHD）患儿的体液分布情况。方法以2011年8月至2012年3月在北京儿童医院血液净化中心因慢性肾衰竭行MHD的9例患儿和171例健康儿童（健康对照组）为研究对象。透析前后分别应用人体成分分析仪，通过多频生物电阻抗法测量MHD患儿透析前后和健康儿童的水负荷（OH）、总体水（TBW）、细胞外液（ECW）、细胞内液（ICW），并分别计算其占体质量的百分比（TBW％、ECW％和ICW％）。结果MHD患儿仅ICW透析前后无明显变化，透析后OH、TBW、ECW、ECW％均较透析前明显下降，ICW％较透析前升高；透析患儿透析前ECW％高于健康对照组，透析后低于健康对照组，ICW％透析前后与健康对照组比较差异无统计学意义。结论MHD患儿存在体液分布异常，主要表现为ECW％显著增加；普通血液透析方法的主要作用是除去多余的ECW，而对ICW无明显影响；多频生物电阻抗法可以对透析患儿的容量状况提供客观依据。

Objective To evaluate the body volume status in maintenance hemodialysis（MHD） children with multi-frequency bioelectrical impedance. Methods Nine end-stage-renal-disease patients undergoing MHD from Aug. 2011 to Mar. 2012 in blood purification department of Beijing Children＇s Hospital and 171 cases of healthy control group were investigated. Over hydration （OH）, total body water（ TBW）, extracellular water（ ECW）, intracellular water （ICW） of MHD children pre-and post-hemodialysis and healthy children were measured with the body composition mo-nitor which was based on multi-frequency bioelectrical impedance and the values were standardized by body weight to produce TBW% ,ECW% and ICW%. Results There were statistical differences of OH,TBW, ECW and ECW% be-fore and after dialysis, but no statistical difference of ICW. By contrast, ECW% values pre-dialysis were higher, but post-dialysis were lower than that of healthy control group. Pre-and post-dialysis ICW% values in HD children were similar to those of healthy control group. Conclusions ECW% increased in MHD children;the main function of nor-mal hemodialysis is to remove extra ECW, which has little effect on ICW. The measurement of multi-frequency bioelec-trical impedance can provide an objective basis for capacity status.