维持性血液透析患者单次透析充分性影响因素分析

Influencing factors of hemodialysis adequacy in maintenance hemodialysis patients

目的探讨维持性血液透析患者常规单次血液透析过程中透析充分性的影响因素。方法选取2016年2月至2017年1月在江苏省中医院血液净化中心规律血液透析的130例患者,观察记录患者的一般情况,性别、年龄、原发病、血管通路及单次血液透析中患者的透析前后尿素氮、透析时间、超滤量、血流量、透析后体质量及超滤量/干体质量(%),利用公式计算得出尿素清除指数(Kt/V)作为评估透析充分性指标。根据Kt/V结果分为达标组(Kt/V≥1.2)与未达标组(Kt/V<1.2),采用独立样本t检验和多元线性回归分析探讨维持性血液透析患者单次血液透析充分性与临床数据的关系。结果独立样本t检验显示单次透析时间(P=0.00)、透析后体质量(P=0.00)、超滤量/干体质量(%)(P=0.02)与Kt/V相关,多元线性回归显示单次透析时间(β=0.365,P<0.05)、透析后体质量(β=-0.47,P<0.05)是单次血液透析Kt/V的独立影响因素,且单次透析时间与Kt/V呈正相关,透析后体质量与Kt/V呈负相关。结论维持性血液透析患者单次血液透析的透析充分性与单次透析时间呈正相关、与透析后体质量呈负相关。

Objective To explore the influencing factors of the hemodialysis adequacy in maintenance hemodialysis（MHD）patients.Methods A total of 130 MHD patients from February 2016 to January 2017 in the Department of Hemopurifacation Center of Jiangsu Provincial Hospital of TCM were enrolled in this study.The data about gender,age,primary diseases,vascular access,and blood urea nitrogen（BUN）pre-HD and post-HD,hemodialysis time,ultrafiltration volume（UF）,blood flow,dry body weight,ratio of UF and dry body weight（%）after single hemodialysis were recorded.The urea clearance index（Kt/V）was calculated as the indicator of the hemodialysis adequacy by Daugirdas Ⅱ formula.According to the Kt/V,two groups were set up：standard attainment group（Kt/V≥1.2）and non-standard attainment group（Kt/V〈1.2）.Independent-samples T test and multiple linear regression analyses were used to examine the association between the hemodialysis adequacy and clinical parameters.Results Independent-samples T test analysis showed that the hemodialysis time（P=0.02）,dry body weight（P=0.00）and ratio of UF and dry body weight（%）（P=0.02）were correlated to Kt/V.Multiple linear regression analysis revealed that the hemodialysis time（β=0.365,P〈0.05）and dry body weight（β=-0.47,P〈0.05）were the independent impact factors of Kt/V.Kt/V was positively correlated with hemodialysis time,and negatively with dry body weight.Conclusions The hemodialysis adequacy in MHD patients is closely associated with hemodialysis time and dry body weight.