中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2012年
13期
8-11
,共4页
肾透析%血容量不足%水肿%N末端脑钠肽前体%容量负荷
腎透析%血容量不足%水腫%N末耑腦鈉肽前體%容量負荷
신투석%혈용량불족%수종%N말단뇌납태전체%용량부하
Renal dialysis%Hypovolemia%Edema%N-terminal pro-brain natriuretic peptide%Capacity load
目的 探讨N末端脑钠肽前体(NT-proBNP)水平对维持性血液透析(MHD)患者容量负荷的预测价值.方法 选取120例MHD患者,根据血压水平分为血压控制不良组(72例)和血压控制良好组(48例).检测透析前后NT-proBNP水平,记录患者心胸比例、左心室质量指数(LVMI)、水肿指数、低血容量发生次数、超滤量并比较,分析NT-proBNP与上述指标的相关性.结果 血压控制不良组的收缩压、舒张压、透析前NT-prpBNP、心胸比例、LVMI、水肿指数、低血容量发生次数分别为( 159.7±18.2) mmHg(1mmHg=0.133 kPa)、(95.3±14.8) mmHg、(11 837.13±1374.26)ng/L、0.61±0.12、( 174.36±21.35) g/m2、2.93±1.72、12例次/周,血压控制良好组分别为(131.6±17.3) mm Hg、( 86.5±13.2) mm Hg、(7649.54±1106.18) ng/L、0.52±0.11、( 151.83±18.94) g/m2、1.02±1.48、26例次/周,两组比较差异有统计学意义(P＜0.01).相关分析显示,透析前后NT-proBNP的差值与超滤量呈显著正相关(P＜0.05);透析前NT-proBNP与收缩压、舒张压、心胸比例、LVMI、水肿指数均呈显著正相关(P＜0.05或＜0.01),而与低血容量发生次数呈显著负相关(P＜0.01).结论 MHD患者NT-proBNP水平与血压、心胸比例、水肿指数、低血容量发生次数、超滤量密切相关,通过检测NT-proBNP水平可更好地评估患者透析中血容量的变化,及时调整透析处方,保证透析的充分性,对提高MHD患者生存质量具有重要意义.
目的 探討N末耑腦鈉肽前體(NT-proBNP)水平對維持性血液透析(MHD)患者容量負荷的預測價值.方法 選取120例MHD患者,根據血壓水平分為血壓控製不良組(72例)和血壓控製良好組(48例).檢測透析前後NT-proBNP水平,記錄患者心胸比例、左心室質量指數(LVMI)、水腫指數、低血容量髮生次數、超濾量併比較,分析NT-proBNP與上述指標的相關性.結果 血壓控製不良組的收縮壓、舒張壓、透析前NT-prpBNP、心胸比例、LVMI、水腫指數、低血容量髮生次數分彆為( 159.7±18.2) mmHg(1mmHg=0.133 kPa)、(95.3±14.8) mmHg、(11 837.13±1374.26)ng/L、0.61±0.12、( 174.36±21.35) g/m2、2.93±1.72、12例次/週,血壓控製良好組分彆為(131.6±17.3) mm Hg、( 86.5±13.2) mm Hg、(7649.54±1106.18) ng/L、0.52±0.11、( 151.83±18.94) g/m2、1.02±1.48、26例次/週,兩組比較差異有統計學意義(P＜0.01).相關分析顯示,透析前後NT-proBNP的差值與超濾量呈顯著正相關(P＜0.05);透析前NT-proBNP與收縮壓、舒張壓、心胸比例、LVMI、水腫指數均呈顯著正相關(P＜0.05或＜0.01),而與低血容量髮生次數呈顯著負相關(P＜0.01).結論 MHD患者NT-proBNP水平與血壓、心胸比例、水腫指數、低血容量髮生次數、超濾量密切相關,通過檢測NT-proBNP水平可更好地評估患者透析中血容量的變化,及時調整透析處方,保證透析的充分性,對提高MHD患者生存質量具有重要意義.
목적 탐토N말단뇌납태전체(NT-proBNP)수평대유지성혈액투석(MHD)환자용량부하적예측개치.방법 선취120례MHD환자,근거혈압수평분위혈압공제불량조(72례)화혈압공제량호조(48례).검측투석전후NT-proBNP수평,기록환자심흉비례、좌심실질량지수(LVMI)、수종지수、저혈용량발생차수、초려량병비교,분석NT-proBNP여상술지표적상관성.결과 혈압공제불량조적수축압、서장압、투석전NT-prpBNP、심흉비례、LVMI、수종지수、저혈용량발생차수분별위( 159.7±18.2) mmHg(1mmHg=0.133 kPa)、(95.3±14.8) mmHg、(11 837.13±1374.26)ng/L、0.61±0.12、( 174.36±21.35) g/m2、2.93±1.72、12례차/주,혈압공제량호조분별위(131.6±17.3) mm Hg、( 86.5±13.2) mm Hg、(7649.54±1106.18) ng/L、0.52±0.11、( 151.83±18.94) g/m2、1.02±1.48、26례차/주,량조비교차이유통계학의의(P＜0.01).상관분석현시,투석전후NT-proBNP적차치여초려량정현저정상관(P＜0.05);투석전NT-proBNP여수축압、서장압、심흉비례、LVMI、수종지수균정현저정상관(P＜0.05혹＜0.01),이여저혈용량발생차수정현저부상관(P＜0.01).결론 MHD환자NT-proBNP수평여혈압、심흉비례、수종지수、저혈용량발생차수、초려량밀절상관,통과검측NT-proBNP수평가경호지평고환자투석중혈용량적변화,급시조정투석처방,보증투석적충분성,대제고MHD환자생존질량구유중요의의.
Objective To investigate the predictive value of N-terminal pro-brain natriuretic peptide (NT-proBNP) level on the capacity load of patients with maintenance hemodialysis (MHD).Methods One hundred and twenty patients undergoing MHD were divided into two groups according to blood pressure levels:bad blood pressure control group with 72 patients and good blood pressure control group with 48 patients.NT-proBNP levels were detected before and after dialysis,and cardiothoracic ratio,left ventricular mass index ( LVMI ),swelling index,number of occurrences of low blood volume and ultrafiltration volume were measured and compared between two groups.The correlation between NT-proBNP and the above indicators was analyzed.Results The systolic blood pressure,diastolic blood pressure,NT-proBNP before dialysis,cardiothoracic ratio,LVMI,swelling index and number of occurrences of low blood volume in bad blood pressure control group respectively were (159.7±18.2) mm Hg (1 mm Hg =0.133 kPa),(95.3±14.8) mm Hg,(11 837.13±1374.26) ng/L,0.61±0.12,(174.36±21.35) g/m2,2.93±1.72,12cases/week,while the indicators in good blood pressure control group were ( 131.6±17.3) mm Hg,(86.5±13.2) mm Hg,(7649.54±1106.18) ng/L,0.52±0.11,( 151.83±18.94) g/m2,1.02±1.48,26 cases/sweek.There were significant differences between two groups (P ＜ 0.01 ).It was showed that NT-proBNP difference between before and after dialysis had significant positive correlation with ultrafiltration volume (P＜ 0.05).NT-proBNP before dialysis had a significant positive correlation with systolic blood pressure,diastolic blood pressure,cardiothoracic ratio,LVMI and swelling index (P ＜ 0.05 or ＜ 0.01 ),while had obvious negative correlation with the number of occurrences of low blood volume(P ＜ 0.01 ).Conclusions NT-proBNP level of MHD patients has close correlation with blood pressure,cardiothoracic ratio,swelling index,number of occurrences of low blood volume and ultrafiltration volume.Detecting the level of NT-proBNP can better evaluate the changes of blood volume in dialysis patients,adjust dialysis prescription in time,and ensure the adequacy of dialysis.It has important significance to improve the quality of life of MHD patients.
