血液透析患者应用生物电阻抗技术对液体管理效果的系统评价

Effectiveness of bioelectrical impedance analysis interventions on volume status in hemodialysis patient：a systematic review

目的评价血液透析患者应用生物电阻抗分析（BIA）干预液体管理的效果。方法计算机检索Cochrane临床对照试验中心注册库、PubMed、EMbase、EBsco、万方数据、WebofScience、中国生物医学文献数据库、中国期刊全文数据库中关于BIA评估血液透析患者液体状态的临床试验研究，检索时限为建库至2016年7月15日。由2名研究员按照纳入和排除标准筛选文献、提取资料、评价质量，然后采用RevMan5．3软件进行Meta分析或描述性分析。结果共纳入6项随机对照研究，1项类试验性研究，3项纵向研究，共2009例患者。Meta分析显示：BIA干预液体管理可改善患者血压（P=0．001）；BIA干预液体管理可保护患者的心脏功能（左心室质量指数，P=0．002）；与临床评估法相比，采用BIA评估血液透析患者干体质量可使住院率降低14％；描述性分析表明：BIA干预液体管理对患者的生存获益有一定优势，但目前研究较少，尚未得出肯定结论。结论BIA可改善血液透析患者的液体状态和干体质量的评估，从而使患者的临床获益和生存获益进一步提高。建议未来优化BIA评估干体质量的方法和政策，鼓励培训临床经验丰富的血液透析护士使用BIA，协助医生更好地评估干体质量，达到优化患者生命质量的效果。

Objective To evaluate the effectiveness of bioelectrical impedance analysis（BIA） interventions on volume status in hemodialysis patient. Methods Searched The Cochrane Library, PubMed, EMbase, EBsco, Wanfang Data, China Biology Medicine, China National Knowledge Infrastructure to collect clinical trials. The retrieval time was from database to July 15, 2016. The studies were selected according to the inclusion and exclusion criteria and were critically appraised by two reviewers. Then the data of included studies were extracted. Meta-analysis was conducted by using RevMan 5.3 software and descriptive analysis. Results Ten clinical trials were included six random control trial, one controlled clinical trail, three longitudinal study, involving 2 009 patients. The results of Meta-analysis showed that the effectiveness of BIA interventions on volume management could improve blood pressure （P=0.001）, protect the heart function（left ventricular mass index,P=0.002）, compared with the clinical evaluation method, the BIA assessment of dry weight of hemodialysis patients could reduce hospitalization rate 14%. Descriptive analysis showed that BIA intervention volume management had certain advantages for the survival benefit of patients, but the current research was still few, had not yet come to a certain conclusion. Conclusions BIA can improve the management of the volume status and dry weight of hemodialysis patients, so as to it can improve the clinical benefit and survival benefit of patients.Better methods and guidelines for assessing DW and using BIA need to be developed.We propose that experienced HD nursing staff be trained in the use of the BIA to help monitor patient over hydration and approximate dry weight in consultation with the nephrologists responsible for the care of these patients so as to obviate excessive residual over hydration between nephrology reviews.