维持性血液透析患者容量负荷的影响因素

Analysis of relative factors of overhydrationin in maintenance hemodialysis patients

目的探讨维持性血液透析患者容量负荷的影响因素,以期更及时有效地调整容量负荷,改善患者预后。方法选取2019年6月至2020年6月在大连市中心医院进行维持性血液透析治疗的205例患者,按透析前测得的水负荷(OH)值,将其分为容量正常组(47例)和容量超负荷组(158例)。记录并分析患者的一般资料以及透析相关参数。结果透析前OH值与收缩压、舒张压呈正相关(均P<0.05),与血红蛋白、前白蛋白、血镁、尿酸、Kt/V、胆固醇、低密度脂蛋白呈负相关(均P<0.05)。多元线性回归分析结果发现,高收缩压(t=2.356,P=0.019)、低血红蛋白(t=-2.492,P=0.014)、低前白蛋白(t=-2.085,P=0.038)、低Kt/V(t=-4.644,P<0.001)、低尿酸(t=-2.094,P=0.037)为OH值升高的独立危险因素。与容量正常组比较,容量超负荷组的血红蛋白、血镁、Kt/V、低密度脂蛋白明显偏低,而收缩压、舒张压明显偏高,差异均有统计学意义(均P<0.05)。两组的性别、白蛋白、前白蛋白、尿酸、C反应蛋白、铁蛋白、甲状旁腺激素、总胆固醇水平比较,差异均无统计学意义(均P>0.05)。结论高收缩压、低血红蛋白、低前白蛋白、低Kt/V、低尿酸为可能为影响血液透析患者容量超负荷的因素,临床工作中应重点关注及时治疗,以期改善患者的预后。

Objective To investigate the relative factors of overhydration in maintenance hemodialysis patients.In order to timely and effectively adjust the volume load,and improve the prognosis of patients.Methods A total of 205 maintenance hemodialysis patients in Dalian municipal central hospital from June 2019 to June 2020 were selected,and divided into normal volume group(47 cases)and volume overload group(158 cases)according to the overhydration(OH)value measured before dialysis.General information and dialysis related parameters were recorded.Results Before dialysis OH value was positively correlated with systolic and diastolic blood pressure(all P<0.05),and negatively correlated with hemoglobin,prealbumin,serum magnesium,uric acid,Kt/V,cholesterol and low density lipoprotein(all P<0.05).Multiple linear regression analysis showed that high systolic blood pressure(t=2.356,P=0.019),low hemoglobin(t=-2.492,P=0.014),low prealbumin(t=-2.085,P=0.038),low Kt/V(t=-4.644,P<0.001)and low uric acid(t=-2.094,P=0.037)were the independent risk factors for the increase of OH value.Compared with the normal volume group,the hemoglobin,serum magnesium,Kt/V,and low density lipoprotein in the volume overload group were significantly lower,while the systolic blood pressure and diastolic blood pressure were significantly higher,and the difference was significant(all P<0.05).There were no significant differences in gender,albumin,prealbumin,uric acid,C-reactive protein,ferritin,parathyroid hormone and total cholesterol between the two groups(all P>0.05).Conclusions High systolic blood pressure,low hemoglobin,low prealbumin,low Kt/V and low uric acid may be the factors that affect the volume overload of hemodialysis patients.In order to improve the prognosis of patients,clinical work should focus on the treatment.