身体成分测量仪评估血液透析患者干体质量的临床意义

The clinical significance of body composition monitor in assessing the dry weight of hemodialysis patients

目的使用身体成分测量仪（BcM）测量临床判断已达干体质量的血液透析患者的容量负荷状态，探讨BCM在评估和调整血液透析患者干体质量中的临床意义。方法选取病情稳定且临床判断已达干体质量的维持性血液透析患者54例。采用BCM测量患者容量负荷，同时收集患者透析前血压、血浆B型脑钠肽（BNP）以及超声心动图指标。结果BCM结果显示，54例血液透析患者，15例于体质量设置过高，13例干体质量设置过低。根据该结果结合临床表现，在之后成功下调了所有容量负荷过重患者的干体质量，部分干体质量设置过低患者也进行了调整。根据BCM患者是否存在容量负荷以及透析前血压将患者分为四组：A组无容量负荷，透析前血压〈150mmHg（1mmHg=0．133kPa），23例；B组无容量负荷，透析前血压≥150mmHg，16例；C组容量负荷过重，透析前血压〈150mmHg，7例；D组容量负荷过重，透析前血压≥150mmHg，8例。上述四组患者的透析前血浆BNP水平以及超声心动图指标比较差异均无统计学意义（P〉0．05）。结论BCM操作简单、方便，可以帮助评估患者容量负荷状态，指导患者干体质量的调节。较临床其他评估方法如足部水肿、高血压以及血浆BNP更准确、实用。

Objective To investigate the clinical significance of body composition monitor （BCM） in evaluating the dry weight of hemodialysis patients. Methods Fifty-four hemodialysis patients who reached the dry weight according to clinical assessment were enrolled. The volume load was measured with BCM, and the pre-dialysis blood pressure, plasma B type natriuretic peptide （BNP） and echocardiogram parameters were recorded. Results BCM results showed that, in 54 hemodialysis patients, 15 patients presented overhydration and 13 patients underhydration. According to the results of BCM, all of the 15 overhydration patients and some of the 13 underhydration patients adjusted their dry weight. According to the BCM results and the pre-dialysis blood pressure, the patients were divided into 4 groups： group A （without overhydration, the pre-dialysis blood pressure 〈 150 mmHg,1 mmHg = 0.133 kPa）, 23 cases; group B （without overhydration, pre-dialysis blood pressure≥ 150 mmHg）, 16 cases; group C （overhydration, pre-dialysis blood pressure 〈 150mmHg）, 7 cases; and group D （overhydration, pre-dialysis blood pressure ≥ 150 mmHg）, 8 cases. There were no significant differences in pre-dialysis, plasma BNP and the echocardiographic parameters among the 4 groups （P 〉 0.05）. Conclusions BCM is a simple and convenient tool to evaluate the volume status of hemodialysis patients. It can give guidance of dry weight regulation. Compared with the other clinical assessment methods such as pedal edema, the blood pressure and plasma BNP, it is more accurate and practical.