直接节段多频生物电阻抗分析技术在血液透析患者干体质量评估中的应用

Application of DSM-BIA technology in dry body mass assessment of hemodialysis patients

目的探讨直接节段多频生物电阻抗分析(DSM-BIA)技术在血液透析(MHD)患者干体质量评估中的应用价值。方法选取行规律MHD治疗3个月以上的非住院患者88例,应用Kraemer评分表观察患者症状体征,根据血容量减少症状、容量状态及有无负荷过重等情况进行严格的临床干体质量调整管控,直至Kraemer评分为0分且持续1周,并将此时的透后体质量作为临床评估干体质量(DWclin)。采用直接节段多频生物电阻抗分析仪测量MHD患者透析前后相关参数,并通过包含年龄、透析后上肢在50 k Hz时的电阻抗数值(R50)、身高以及透后BMI等参数的CB公式计算干体质量(DWDSM-BIA–CB)。观察MHD患者透析前后不同部位的DWDSM-BIA–CB值差异,并绘制Bland-Altman图对2种干体质量评估方法评估值进行一致性分析。结果 MHD患者血液透析前后躯干部R50水平均显著低于内瘘对侧上肢R50、下肢R50(P<0.01);血液透析后内瘘对侧上肢R50、躯干R50、下肢R50分别较透析前显著升高(P<0.05);本组DWclin平均(66.3±13.2)kg,Bland-Altman图形分析显示DWclin和男/女性MHD的DWDSM-BIA–CB值一致性均较好。本组血透中仅有2例老年终末期肾病患者出现感染症状。结论 DSM-BIA技术能较好反映血透患者的容量负荷,结合严格的临床管控结果可进行准确的干体质量评估,对指导临床血透方案、降低并发症等具有显著应用价值。

Objective To explore the application value of direct segmental multi frequency bioelectrical impedance analysis（ DSM-BIA） technology in dry weight assessment of hemodialysis（ MHD） patients. Methods A total of 88 non-hospitalized patients who had been regular treated with MHD for more than 3 months were selected. The symptoms and signs were observed by the Kraemer score table. The severe clinical dry weight adjustment was controlled according to the symptoms,capacity state and excessive load,until the Kraemer score was 0 and lasted for 1 weeks,and was used to as dry weight（ DWclin）. A direct segmental multifrequency bioelectrical impedance analyzer was used to measure the parameters of MHD patients before and after dialysis,and the dry weight（ DWDSM-BIA – CB） was calculated by the CB formula including age,the electrical impedance value（ R50） of the upper limb at 50 k Hz,and the CB formula of the height and post transtransdermal BMI parameters. The difference of DWDSM-BIA-CBvalue of different parts of MHD patients before and after dialysis was observed,and the Bland-Altman map was plotted for the consistency analysis of the evaluation values of two kinds of dry weight evaluation methods. Results After hemodialysis,the level of R50 level in MHD patients was significantly lower than that of R50 of lateral upper limb of the internal fistula and R50 in the lower limb（ P〈0. 01）. R50 of lateral upper limb of the internal fistula,trunk R50 and lower extremity R50 after hemodialysis were increased as compared with hemdialysis before（ P〈0. 05）,and the average of DWclinwas（ 66. 3 ± 13. 2） kg in this group,and the Bland-Altman figure analysis showed that DWclin had a favorable accordance with DWDSM-BIA-CBvalues of male/female MHD. Only 2 cases of senile end-stage renal disease were infected. Conclusion DSM-BIA technique can better reflect the volume load of hemodialysis patients,and can evaluate the dry weight accurately with the strict clinical management results. So it is of great value in guiding the clinical hemodialysis scheme and reducing the complications.