生物电阻抗分析法评估急性肾损伤行CRRT患者液体负荷变化的价值

Significance of bioelectrical impedance vector analysis in evaluating fluid load in patients with acute kidney injury undergoing continuous renal replacement therapy

目的探讨应用生物电阻抗分析法(BIVA)评估急性肾损伤(AKI)行连续性肾脏替代治疗(CRRT)患者液体负荷变化的价值。方法选取22例终末期肾脏病行维持性血液透析的患者(透析组)、35例AKI行CRRT的患者(CRRT组)和14例健康志愿者(正常对照组),在透析组和CRRT组透析前后、正常对照组饮水前后行BIVA检测,分析三组体重变化、前后两次BIVA检测之间的净出入量与BIVA液体负荷变化值的相关性。结果三组中,正常对照组饮水前后BIVA参数变化值最小,透析组透析前后BIVA参数变化值最大。透析组和CRRT组透析前后两次BIVA检测之间的净出入量与液体负荷变化值差异均无统计学意义(P>0.05)。透析组和CRRT组体重变化与BIVA参数中全身水含量、细胞外液及液体负荷变化值相关(P<0.05),但与细胞内液变化值无明显相关性(P>0.05)。结论 AKI行CRRT患者可应用BIVA评估液体负荷的变化,指导容量管理。

Objective To investigate the significance of bioelectrical impedance vector analysis（BIVA）in evaluating fluid load in the patients with acute kidney injury（AKI）undergoing continuous renal replacement therapy（CRRT）.Methods BIVA was carried out in 22 patients with end-stage renal disease undergoing maintenance hemodialysis（group A）,35 patients with AKI undergoing CRRT（group B）before and after dialysis,and 14 healthy people（group C）before and after drinking water500 ml.The correlation between net fluid removal and the changes of BIVA parameters were analyzed in three groups.Results Among three groups,the variation of BIVA parameters in group C was minimum,which in group A was maximum.There were no significant differences in net fluid removal and overhydration changes between before hemodialysis and after hemodialysis in groups of A and B（P〉0.05）.Weight change was related to BIVA parameters such as total body water,extracellular water and overhydration（P〈0.05）,but not significantly related to intracellular water in groups of A and B（P〉0.05）.Conclusion BIVA can be applied in evaluating the changes of fluid load and guiding volume management in the patients with AKI undergoing CRRT.