在线尿素清除率监测及其临床意义

Evaluation of clinkal efficiency of online clearance measurement in maintenance hemodialysis patients

目的 探讨在线尿素清除率监测(OCM)的临床应用价值及在透析充分性评价中的临床意义。方法 采用4008S血液透析机OCM检测了38例维持性透析患者一次血液透析时的尿素清除指数(Kt/V值),并用尿素动力一室模型计算Kt/V值;根据有、无残余肾功能,将38例分为两组对OCM和计算Kt/V值进行比较。结果 38例患者OCM检测Kt/V值为1.13±0.58,计算Kt/V值为1.18±0.17,具有良好的相关性(r=0.887,P<0.01)。尿素动力模型计算二组的Kt/V值有显著差异(P<0.05),而OCM检测其Kt/V值则无显著差异(P>0.05)。结论 血液透析机OCM可作为检测Kt/V,评价透析充分性的简便、可靠的指标,并可避免透析后尿素反弹和残余肾功能的影响。

Objective To evaluate the clinical efficiency of online clearance measurement (OCM) based on conductivity variation. Methods Kt/V were assessed both by OCM and urea kinetic model in 38 maintenance hemodialysis patients, of which 2 groups were separated according to their residual renal function. Results Kt/V as estimated by OCM were 1.13±0.58, whereas measurements of Kt/V were 1.18±0.17 by urea kinetic model. They showed highly significant linear correlation( r = 0.887, P < 0.01). Measurements of Kt/V by urea kinetic model had significant differences between 2 groups( P < 0.05), while Kt/V as estimated by OCM had no significant differences( P > 0.05). Conclusion The OCM option of the hemodialysis machine provides an accurate tool for online monitoring of urea clearance to evaluate dialysis adequacy.