中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
2011年
4期
247-252
,共6页
陈月梅%丁小强%滕杰%邹建洲%刘中华%王一梅%沈波%曹学森
陳月梅%丁小彊%滕傑%鄒建洲%劉中華%王一梅%瀋波%曹學森
진월매%정소강%등걸%추건주%류중화%왕일매%침파%조학삼
血液透析%体重增长%血压%残余尿
血液透析%體重增長%血壓%殘餘尿
혈액투석%체중증장%혈압%잔여뇨
Hemodialysis%Weight gain%Hypertension%Residual urine
目的 了解维持性血液透析(MHD)患者透析间期的体质量增长情况及影响因素.方法 对复旦大学中山医院肾脏科血液净化中心269例MHD患者作横断面研究.根据患者透析间期体质量增长率(体质量增长量/干体质量×100%)将患者分为≤3.50%(79例)及＞3.50%(190例)两组,分析影响透析间期体质量增长的因素.结果 269例MHD患者体质量增长量为(2.42±1.01)kg(0～6.33 kg),体质量增长率为(4.25±1.79)%.男性160例,体质量增长量为(2.45±1.09)kg,体质量增长率为(3.99±1.79)%;女性109例,体质量增长量为(2.39±0.85)kg,体质量增长率为(4.64±1.74)%,显著高于男性(P＜0.01).透析间期体质量增长率＜3.00%的患者占20%,≥3.00%且＜5.00%的占50%,≥5.00%占30%.73.5%的患者体质量增长率超过3.50%.与体质量增长率＞3.50%组比较,≤3.50%组的年龄(岁)(60.50±14.49比54.07±13.78)、男性比例(70.88%比54.74%)、体质量指数(BMI,kg/m2)(22.67±3.36比20.91±3.25)、残余尿量(ml)(自然对数:6.19±0.94比5.48±0.81)、干体质量(kg,62.82±10.97比56.69±10.94)及透析频次明显较高(均P＜0.05);血液透析龄(月)(41.03±41.92比58.83±43.57),β2微球蛋白(mmol/L)(31.61±9.82比38.54±10.38)及血磷(mmol/L)(1.92±0.66比2.15±0.58)显著较低(均P＜0.05).相关分析显示体质量增长率与透析龄、透析前Scr、BUN、磷、β2微球蛋白、透析期间血压下降值和下降率呈正相关,其中透前BUN、Scr、磷及β2微球蛋白经残余尿量校正后,相关性无统计学意义;与年龄、干体质量、BMI、透后收缩压、平均血压及残余尿量呈负相关.结论 本组近70%患者体质量增长率控制在5%以内.年龄小、女性、BMI低、残余尿茸少、干体质量低、透析龄长、基础病因为慢性肾小球肾炎及糖尿病肾病患者在透析间期体质量增长较多.体质量增长显著影响透析期间的血压变化,应加强MHD患者透析间期的体质量增长的控制.
目的 瞭解維持性血液透析(MHD)患者透析間期的體質量增長情況及影響因素.方法 對複旦大學中山醫院腎髒科血液淨化中心269例MHD患者作橫斷麵研究.根據患者透析間期體質量增長率(體質量增長量/榦體質量×100%)將患者分為≤3.50%(79例)及＞3.50%(190例)兩組,分析影響透析間期體質量增長的因素.結果 269例MHD患者體質量增長量為(2.42±1.01)kg(0～6.33 kg),體質量增長率為(4.25±1.79)%.男性160例,體質量增長量為(2.45±1.09)kg,體質量增長率為(3.99±1.79)%;女性109例,體質量增長量為(2.39±0.85)kg,體質量增長率為(4.64±1.74)%,顯著高于男性(P＜0.01).透析間期體質量增長率＜3.00%的患者佔20%,≥3.00%且＜5.00%的佔50%,≥5.00%佔30%.73.5%的患者體質量增長率超過3.50%.與體質量增長率＞3.50%組比較,≤3.50%組的年齡(歲)(60.50±14.49比54.07±13.78)、男性比例(70.88%比54.74%)、體質量指數(BMI,kg/m2)(22.67±3.36比20.91±3.25)、殘餘尿量(ml)(自然對數:6.19±0.94比5.48±0.81)、榦體質量(kg,62.82±10.97比56.69±10.94)及透析頻次明顯較高(均P＜0.05);血液透析齡(月)(41.03±41.92比58.83±43.57),β2微毬蛋白(mmol/L)(31.61±9.82比38.54±10.38)及血燐(mmol/L)(1.92±0.66比2.15±0.58)顯著較低(均P＜0.05).相關分析顯示體質量增長率與透析齡、透析前Scr、BUN、燐、β2微毬蛋白、透析期間血壓下降值和下降率呈正相關,其中透前BUN、Scr、燐及β2微毬蛋白經殘餘尿量校正後,相關性無統計學意義;與年齡、榦體質量、BMI、透後收縮壓、平均血壓及殘餘尿量呈負相關.結論 本組近70%患者體質量增長率控製在5%以內.年齡小、女性、BMI低、殘餘尿茸少、榦體質量低、透析齡長、基礎病因為慢性腎小毬腎炎及糖尿病腎病患者在透析間期體質量增長較多.體質量增長顯著影響透析期間的血壓變化,應加彊MHD患者透析間期的體質量增長的控製.
목적 료해유지성혈액투석(MHD)환자투석간기적체질량증장정황급영향인소.방법 대복단대학중산의원신장과혈액정화중심269례MHD환자작횡단면연구.근거환자투석간기체질량증장솔(체질량증장량/간체질량×100%)장환자분위≤3.50%(79례)급＞3.50%(190례)량조,분석영향투석간기체질량증장적인소.결과 269례MHD환자체질량증장량위(2.42±1.01)kg(0～6.33 kg),체질량증장솔위(4.25±1.79)%.남성160례,체질량증장량위(2.45±1.09)kg,체질량증장솔위(3.99±1.79)%;녀성109례,체질량증장량위(2.39±0.85)kg,체질량증장솔위(4.64±1.74)%,현저고우남성(P＜0.01).투석간기체질량증장솔＜3.00%적환자점20%,≥3.00%차＜5.00%적점50%,≥5.00%점30%.73.5%적환자체질량증장솔초과3.50%.여체질량증장솔＞3.50%조비교,≤3.50%조적년령(세)(60.50±14.49비54.07±13.78)、남성비례(70.88%비54.74%)、체질량지수(BMI,kg/m2)(22.67±3.36비20.91±3.25)、잔여뇨량(ml)(자연대수:6.19±0.94비5.48±0.81)、간체질량(kg,62.82±10.97비56.69±10.94)급투석빈차명현교고(균P＜0.05);혈액투석령(월)(41.03±41.92비58.83±43.57),β2미구단백(mmol/L)(31.61±9.82비38.54±10.38)급혈린(mmol/L)(1.92±0.66비2.15±0.58)현저교저(균P＜0.05).상관분석현시체질량증장솔여투석령、투석전Scr、BUN、린、β2미구단백、투석기간혈압하강치화하강솔정정상관,기중투전BUN、Scr、린급β2미구단백경잔여뇨량교정후,상관성무통계학의의;여년령、간체질량、BMI、투후수축압、평균혈압급잔여뇨량정부상관.결론 본조근70%환자체질량증장솔공제재5%이내.년령소、녀성、BMI저、잔여뇨용소、간체질량저、투석령장、기출병인위만성신소구신염급당뇨병신병환자재투석간기체질량증장교다.체질량증장현저영향투석기간적혈압변화,응가강MHD환자투석간기적체질량증장적공제.
Objective To study interdialytic body weight gain(IBWG)in maintenance hemodialysis(MHD)patients,and to analyze the associated factors. Methods A total of 269 patients undergoing maintenance hemodialysis were enrolled in this cross-sectional study.The patients were divided into two groups according to the percentage of IBWG(PIBWG:interdialytic body weight gain/dry weight×100%):PIBWG＞3.50%(190 cases)and PIBWG≤3.50%(79 cases).Associated factors of IBWG were analyzed. Results The average IBWG of 269 MHD patients was(2.42±1.01)kg(0-6.33 kg),and PIBWG was(4.25±1.79)%.In male patients,IBWG was (2.45±1.09)kg,and PIBWG was(3.99±1.79)%.In female patients,IBWG was(2.39±0.85)kg,and PIBWG was(4.64±1.74)%which was significantly higher compared to males(P＜0.01).Patients with PIBWG＜3.00%accounted for 20%,with PIBWG≥3.00%to＜5.00%accounted for 50%,with PIBWG≥5.00%accounted for 30%.Compared to patients with PIBWG＞3.50%,those with PIBWG≤3.50%were characterized by elder age(year)(60.50 ±14.49 vs 54.07±13.78),more males(70.88%vs 54.74%),shorter dialysis duration(month)(41.03±41.92 vs 58.83±43.57),larger BMI(kg/m2)(22.67±3.36 vs 20.91±3.25)and less dry weight(kg)(56.69±10.94 vs 62.82±10.97),more residual urine(ml,In)(6.19±0.94 vs 5.48±0.8),lower predialysis serum β2MG(mmol/L)(31.61±9.82 vs 38.54±10.38)and phosphorus(mmol/L)(1.92±0.66 vs 2.15±0.58).Correlation analysis revealed that PIBWG was positively correlated with dialysis duration,Scr,BUN,β2-MG,phosphorus,decrease and decrease percentage of BP during hemodialysis,and negatively correlated with age,dry weight,BMI,residual urine,and pre-dialysis SBP,MAP. Conclusions PIBWG of about 70%of our patients was below 5%.Young.female.low BMI and dry body weight,long dialysis duration,low residual urine,chronic glomerulonephritis and diabetic nephropathy are associated with more IBWG,which may lead to greater intradialytic BP fluctuation.
