一项关于血液透析废液收集的方法学研究

A methodology study on spent dialysate collection

目的探索使用一种全新的、既简便又精确的工具收集透析废液样本数据的准确性。方法随机选取南宁市栖霞区妇幼保健院血液净化中心病情稳定、长期且每周行3次血液透析的患者30名,于每周中间一次透析时,分别同时用2种方法,即专利方法和传统方法收集整个一次完整透析过程(4h)中所产生的透析废液,然后分别检测2种方法所收集透析废液的磷、尿素氮(BUN)、肌酐(Cr)、尿酸(UA),所得数据分别归为专利组和传统组。同时再通过使用性别、年龄、透析器参数、透析60 min时透析废液磷浓度等数据,用公式法算得该次透析磷的清除总量数据归为公式组。结果专利组血液透析废液磷、BUN、Cr、UA清除总量分别为(27.60±8.39)mmol、(458.15±187.83)mmol、(14 676.46±5 593.39)μmol、(6 341.61±2 193.88)μmol,传统组血液透析废液磷、BUN、Cr、UA清除总量分别为(27.75±8.45)mmol、(464.78±193.91)mmol、(15 121.93±5 919.89)μmol、(6 412.32±2 213.69)μmol,2组在统计学上比较均无显著差异(P>0.05),相关系数分别为0.996、0.996、0.942、0.993。公式组和传统组血液透析废液磷清除总量分别为(32.8±28.03)mmol、(27.75±8.45)mmol,2组比较有统计学差异(t=6.35,P<0.01)。结论新方法完全可以替代传统的金标准法用于收集血液透析废液,使用其所得样本检测出的物质清除总量与传统方法非常一致,而且明显优于公式法。

Objective To explore the accuracy of using a new kind of both simple and accurate tool to collect spent dialysate.Methods Thirty patients receiving maintenance hemo dialysis（MHD）in a stable condition were enrolled from our blood purification center.The patent method and the traditional method were used respectively to collect the spent dialysate of a whole dialysis（4 h）during the second treatment of a week.Phosphorus,urea nitrogen,creatinine and uric acid of the spent dialysate collected by two methods were determined,and the obtained data were classified as ＂patent group＂and＂traditional group＂.Meanwhile,by the use of data about gender,age,parameters of the dialyzer,and phosphorus concentration of spent dialysate which was collected after the dialysis for 60 min,a formula was used to calculate phosphorus removal amount of a whole dialysis procedure,and the obtained data were classified as＂formula group＂.Results The total removal amounts of phosphorus,urea nitrogen,creatinine and uric acid in the patent group and traditional group were（27.60±8.39）vs.（27.75±8.45）mmol;（458.15±187.83）vs.（187.83±193.91）mmol;（14 676.46±5 593.39）vs.（5 593.39 ± 5 919.89）μmol;（6 341.61 ± 2 193.88）vs.（6 412.32 ±2 213.69）μmol,respectively.There were no statistically significant differences between the two groups（P〉0.05）,and the correlation coefficient was 0.996 for all.The total removal amounts of phosphorus in the formula group and traditional group were（32.8±28.03）vs.（27.75±8.45）mmol respectively.There were statistically significant differences between the two groups（t=6.35,P〈0.01）,and the correlation coefficient r=0.860.Conclusions The new method can perfectly replace the traditional or gold standard method to collect spent dialysate of a whole dialysis procedure.The detected removal amounts of various materials in the samples obtained by this new method are very consistent with those by the traditional method.Furthermore,the new method is significantly superior to the formula method.