无创血流动力学监测对血液透析患者干体重的评价

山东大学学报(医学版)

无创血流动力学监测对血液透析患者干体重的评价

刘金彦，朱彬，李苏，王小平，刘子栋

山东大学医学院济南市中心医院肾脏病血液净化中心，山东　济南　250012

收稿日期:2006-09-19 修回日期:1900-01-01 出版日期:2007-07-24 发布日期:2007-07-24
通讯作者: 刘子栋

The role of noninvasive hemodynamic monitoring in evaluating dry weight following hemodialysis

LIU Jin-yan, ZHU Bin, LI Su, WANG Xiao-ping, LIU Zi-dong

Haemodialysis Centre, Jinan Central Hospital, School of Medicine, Shandong University, Jinan 250012, Shandong, China

Received:2006-09-19 Revised:1900-01-01 Online:2007-07-24 Published:2007-07-24
Contact: LIU Zi-dong

摘要/Abstract

摘要： 目的：探讨无创血流动力学监测系统对血液透析患者透析前后胸腔液体成分(TFC)变化的监测及对调整合适干体重(DW)的临床意义。方法：选取规律血液透析(HD)患者37例，分为血压控制满意组(A组，18例)，难治性高血压组(B组，19例)，并选取健康志愿者为对照组(C组，16例)，HD患者入选时用无创血流动力学监测仪监测透析前后TFC、收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)；根据TFC水平，透析后仍高于正常的逐渐调整HD超滤量下调干体重，4周后再次测量透析后的上述指标，并与C组对照。结果:①入选时透析前A、B组男、女分组示TFC均较C组高与C组差异有显著性(P＜0.05)，透析后两组均有降低，但B组仍较高与C组比较差异有显著性(P＜0.05)；根据透析后TFC水平逐渐调整B组HD超滤量，4周透析后TFC水平、血压均较前有明显降低，差异有统计学意义(P＜0.05)；②B组透析后TFC水平与平均动脉压(MAP)呈显著正相关(P＜0.01)，调整超滤前后TFC差值与平均动脉压差值呈显著正相关(P＜0.01)。结论:无创血流动力学监测系统可以准确评价规律血液透析患者容量状态，对确定患者合适的干体重有重要的临床应用价值。

Abstract: Objective: To evaluate the diversity of thoracic fluid content (TFC) in dialysis patients before and after HD using the noninvasive hemodynamic monitor and to investigate its clinical application in modulating a suitable dry weight (DW). Methods: Thirty-seven patients were selected and divided into two groups based on their blood pressure: 18 patients with controlled hypertension (group A) and 19 patients with hypertension that was difficult to control (Group B). Sixteen healthy volunteers were enrolled in the control group (group C). A noninvasive hemodynamic monitor was utilized to determine the variation of thoracic fluid content (TFC), weight, systolic blood pressure (SBP), diastolic blood pressure (DBP) and ultra-filtration volume in patients before and after HD. The dry weight and volume of ultra-filtration were gradually modulated when TFC levels were above normal. Patients were re-evaluated with a noninvasive hemodynamic monitor 4 weeks after the initial assessment. SPSS software was used to analyze the data. Results: (1) The TFC level was significantly higher in groups A and B than in group C before HD (P＜0.05), and was dramatically reduced following HD in groups A and B. The TEC level in group B was still significantly higher than in group C. However, it decreased to normal after the dry weight and ultrafiltration volume were modified. The DBP/SBP were significantly reduced (P＜0.05) after the initial HD and eventually returned to a normal range 4 weeks after HD. (2) The post-HD TFC level in group B correlated well with the reduced mean arterial pressure (P＜0.01). The difference of the reduced TFC levels between the initial post-HD and post-HD after modification correlated well with the decreased BP post-HD (P＜0.01). Conclusion: The noninvasive hemodynamic monitoring method can be effectively used to evaluate the volume state in patients requiring HD, and has a significant clinical value in determining a suitable dry weight for these patients.

Key words: Hemodynamics, Dry weight, Hemodiafiltration

中图分类号:

R459.5

刘金彦,朱彬,李苏,王小平,刘子栋. 无创血流动力学监测对血液透析患者干体重的评价[J]. 山东大学学报(医学版), 2007, 45(7): 688-691.

LIU Jin-yan,ZHU Bin,LI Su,WANG Xiao-ping,LIU Zi-dong. The role of noninvasive hemodynamic monitoring in evaluating dry weight following hemodialysis[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2007, 45(7): 688-691.

参考文献

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed

[1]	梁波. 连续性静脉-静脉血液滤过治疗严重乳酸性酸中毒临床观察[J]. 山东大学学报（医学版）, 2014, 52(S2): 31-31.
[2]	赖小航, 杨沛华. 不同血液透析模式对外周血非对称性二甲基精氨酸及血压的影响[J]. 山东大学学报（医学版）, 2014, 52(S2): 25-26.
[3]	王静, 李娟. 无肝素血液透析的疗效及护理体会[J]. 山东大学学报（医学版）, 2014, 52(Z1): 185-186.
[4]	王会1，王菊生2，时一民1，姚子明3，孙云1，肖合存1，赵晓田4，赵长峰4. 维持性血液透析患者营养状况分析[J]. 山东大学学报(医学版), 2011, 49(9): 59-.
[5]	王尊松1，崔美玉1，张磊2，许冬梅1. 血液透析患者促红细胞生成素抵抗的相关性研究[J]. 山东大学学报(医学版), 2010, 48(11): 129-132.
[6]	王尊松1，张瑞凤2，许冬梅1，崔美玉1 . 超纯透析液对血液透析患者促红细胞生成素抵抗的影响[J]. 山东大学学报(医学版), 2010, 48(12): 90-93.
[7]	李凤波, 高晓芳, 王小双. 基层医院维持性血液透析患者生存质量相关影响因素调查分析[J]. 山东大学学报（医学版）, 2014, 52(S1): 46-46.