治疗代谢性酸中毒对维持性血透患者营养状况的影响

The Impact of Treating Metabolic Acidosis on the Nutritional Status of the Patients on Chronic Hemodialysis

目的观察治疗代谢性酸中毒对维持性血透患者营养状况的影响。方法选择38例大于3个月稳定血液透析的维持性血透患者,口服碳酸氢钠1g,3次/日,共16周,评价纠正酸中毒对净体重、蛋白质代谢分解率(PCRn)和血清白蛋白浓度的影响。比较治疗酸中毒前后血清碳酸氢钠浓度、血清pH值、血清白蛋白、血清总蛋白、血清肌酐、血清钠浓度、血红蛋白、PCRn、尿素的时间平均浓度(TACurea)和尿素清除指数(K/TV)。结果血清碳酸氢钠浓度和血pH值增加,前者从(16.3±2.1)mmol/L到(21.6±3.2)mmol/L(P<0.001),后者从7.33±0.06到7.39±0.04(P<0.001)。患者净体重从(56.2±12.3)kg增加到(58.3±11.7)kg(P<0.01)。血清白蛋白浓度从(33.5±2.3)g/L增加到(35.3±2.9)g/L(P<0.01)。PCRn从(1.12±0.12)g/(kg·d)降至(1.00±0.11)g/(kg·d)(P<0.001)。而血清总蛋白、血清肌酐、血清钠浓度、血红蛋白、TACurea、K/TV、血透前血压、透析间期体重变化的差异均无统计学意义。结论代谢性酸中毒纠正后可增加患者净体重,改善血清白蛋白,但PCRn降低。在评价和改善维持性血透患者的营养状况时治疗酸中毒必须首先考虑。

Objective To study the effect of treating metabolic acidosis on the nutritio nal status of the patients on chronic hemodialysis.Methods In this study we o bserved the effect of16-week treatment of metabolic acidosis by oral sodium b icarbonate supplementation,measuring protein catabolic rate(PCRn)and serum al bumin concentrations in38patients with maintenance hemodialysis (HD)for at l east3months.Pre-dialysis serum bicarbonate,arterial pH,serum albumin,total serum proteins,serum creatinine,plasma sodium,haemoglobin,PCR n ,KT/V and TACurea were evaluated before and after the correction of metabol ic acidosis.Results Serum bicarbonate levels and arterial pH increased from(1 6.3±2.1)mmol/L to(21.6±3.2)mmol/L,(P<0.001)and(7. 33±0.06to7.39±0.04),(P<0.001)respectively.The net bod y weight increased from(56.2±12.3)kg to(58.3±11.7)kg(P< 0.01).Serum albumin level increased from(33.5±2.3)g /L to(35 .3±2.9)g /L(P<0.01),while PCRn decreased from(1.12±0.12 )g/(kg·d)to(1.00±0.11)g /(kg·d)(P<0.001).No changes were found in KT/V,total serum proteins,serum creatinine,plasma sodium,haem oglobin,pre-dialysis systolic and diastolic blood pressure,and intradialytic w eight gain.Conclusions The treatment of metabolic acidosis could increase se rum albumin concentration,improve malnutrition and decrease morbidity and morta lity in HD patients.