生物电阻抗评估血液滤过患者血容量及心功能的价值

Value of multi-frequency bioelectrical impedance to evaluating blood volume and cardiac function in patients receiving hemofiltration

目的探讨生物电阻抗指标评价慢性肾脏病5期血液滤过患者血容量与心脏结构及功能的价值。方法慢性肾脏病5期行血液滤过治疗患者52例（CKD组）,以血液滤过中中心静脉压6~12cm H2O为容量平衡标准,观察患者治疗前、后中心静脉压、血生化指标及心脏超声结果;以健康成人52例为对照组,测量对照组及CKD组治疗前、后生物电阻抗指标。结果 （1）CKD组治疗前中心静脉压为（16.34±3.47）cm H2O,细胞外液占总体水含量百分比（percentage of extracellular fluid in total body water,ECW/TBW%）为（27.86±3.52）%、总水含量占体质量百分比（percentage of total water in body weight,TBW%）为（58.68±5.23）%,治疗后以上指标分别为（9.25±3.51）cm H2O、（24.67±3.55）%、（56.57±4.35）%,治疗前后比较差异有统计学意义（P〈0.01）;（2）CKD组治疗后室间隔厚度[（11.45±0.96）mm]、左心室后壁厚度[（10.76±0.95）mm]、左室射血分数[（62.74±4.02）%]与治疗前[（11.97±1.13）mm、（11.25±0.92）mm、（60.35±4.66）%]比较差异有统计学意义（P〈0.05）;（3）CKD组治疗后ECW%/TBW、TBW%与对照组[（24.33±3.48）%、（55.36±3.89）%]比较差异无统计学意义（P〉0.05）。结论生物电阻抗指标可准确评估慢性肾脏病5期患者容量负荷。

Objective To explore the value of multi-frequency bioelectrical impedance analysis（MBIA）to evaluating blood volume as well as cardiac structure and function in patients with chronic kidney disease（CKD）stageⅤtreated by hemofiltration（HF）.Methods Fifty-two patients receiving HF for CKD stageⅤ（CKD group）were measured central venous pressure（CVP）,laboratory parameters,and cardiac ultrasound results before and after treatment with the capacity balancing standard of CVP from 6to 12 cm H2O.Another health volunteers were as controls（control group）.The MBIA indexes were measured before and after treatment in both groups.Results In CKD group,CVP,percentage of extracellular fluid in total body water（ECW/TBW%）and percentage of total water in body weight（TBW%）were（9.25±3.51）cm H2 O,（24.67±3.55）% and（56.57±4.35）% after treatment,significantly different from those before treatment（（16.34±3.47）cm H2 O,（27.86±3.52）%,（58.68±5.23）%）（P0.01）.There were significant differences in interventricular septum thickness（（11.97±1.13）vs（11.45±0.96）mm）,left ventricular posterior wall thickness（（11.25±0.92）vs（10.76±0.95）mm）and left ventricular ejection fraction（（60.35±4.66）% vs（62.74±4.02）%）before and after treatment in CKD group（P0.05）.There were no significant differences in ECW/TBW%and TBW% between CKD group after treatment and control group（（24.33±3.48）%,（55.36±3.89）%）（P0.05）.Conclusion The detection of MBIA indexes can accurately evaluate the volume loading in patients with CKD stageⅤ.