中国血液净化

中国血液净化 ›› 2021, Vol. 20 ›› Issue (02): 73-76.doi: 10.3969/j.issn.1671-4091.2021.02.001

• 临床研究 •    下一篇

终末期肾病血液透析患者肺功能与体液状态的关系研究

任丽丽1,刘胜阳1,李松梅1   

  1. 1辽阳市中心医院血液净化中心
  • 收稿日期:2020-09-10 修回日期:2020-12-09 出版日期:2021-02-12 发布日期:2021-02-23
  • 通讯作者: 任丽丽 mina002a@163.com E-mail:mina002a@163.com

Study on the relationship between lung function and body fluid state in hemodialysis patients with endstage renal disease 

  1.  1Blood Purification Center，Liaoyang Central Hospital, Liaoyang 111000, China
  • Received:2020-09-10 Revised:2020-12-09 Online:2021-02-12 Published:2021-02-23

PDF

845

摘要： 【摘要】目的探索接受血液透析的终末期肾病(end-stage renal disease，ESRD)患者液体状态和肺功能之间的关系。方法2019 年4 月～10 月，纳入在辽阳市中心医院血液净化中心接受血液透析的ESRD 患者54 例。在透析前和透析后，测量患者的呼吸功能，同时采用电阻抗分析方法(bioimpedance analysis,BIA)测量患者的水负荷(overhydration,OH)和细胞外液(extracellular water,ECW)，并计算
2 者的百分比(OH/ECW%)。OH/ECW%＞7%视为液体超载。结果血液透析后用力肺活量(forced vital capacity,FVC)、FVC 占预计量的百分比(forced vital capacity as a percentage of predicted normal value，FVC%)和第1 秒的用力呼气容积(forced expiratory volume in one second,FEV1)水平显著升高，而OH/ECW%降低(t 值分别为2.213、2.389、2.327、15.117，P 值分别为0.030、0.019、0.022、＜0.001)。透析前共有15 例(27.8%)患者发生了液体超载。液体超载组的FVC、FVC%、FEV1、FEV1占预计量的百分比(FEV1 as a percentage of predicted normal value，FEV1%)、用力呼出气量为25%～75%肺活量时的平均流量(forced expiratory flow between 25% and 75% of the FVC,FEF25-75)、呼出肺活量25%～75%时的用力呼气流量占预计量百分比(forced expiratory flow between 25% and 75% of the FVC as a percentage of predicted normal values,FEF25- 75% )、呼气峰值流速(peak expiratory
flow rate,PEFR)、呼气峰值流速占预计量的百分比(peak expiratory flow rate as a percentage of predicted normal value,PEFR% )均低于无液体超载组(t 值分别为4.740、5.131、4.902、6.226、4.263、3.668、2.904、3.694，P 值分别为＜0.001、＜0.001、＜0.001、＜0.001、＜0.001、＜0.001、0.005、＜0.001)。透析前OH/ECW%与FVC、FVC%、FEV1、FEV1%、FEF25–75、FEF25–75%、PEFR、PEFR%呈负相关(r 值分别为–0.411、–0.530、–0.395、–0.491、–0.307、–0.272、–0.302、–0.425，P 值分别为0.002、＜0.001、0.003、＜0.001、0.024、0.047、0.027、0.001)。多元线性回归分析模型显示，透析后，男性性别和超滤量的增加与较高的FVC 独立相关(β 值分别为0.341、0.218，95%CI:0.290～1.220、0.010～0.398；P 值分别为0.002、0.040)，而年龄的增加和OH/ECW%比值与较低的FVC 独立相关(β 值分别为–0.419、–0.314，95% CI:–0.046 ～–0.017、–0.064 ～–0.015，P 值分别为＜0.001、0.002)。结论在维持血液透析的ESRD 患者中，液体超载与患者呼吸功能呼吸异常密切相关。血液透析对肺功能有显著的改善作用，这可能得益于透析后液体超载的缓解。

关键词: 终末期肾病, 血液透析, 肺功能, 液体超载, 生物电阻抗分析

Abstract: 【Abstract】Objective To explore the relationship between fluid status and lung function in hemodialysis patients with end-stage renal disease (ESRD). Methods From April to October 2019, 54 ESRD patients receiving hemodialysis in the blood purification center of our hospital were enrolled. Respiratory function was measured before and after hemodialysis, and overhydration (OH), extracellular water (ECW), and OH/ECW% were measured using the DSM-BIA method. OH/ECW＞7% is considered overhydration. Results The levels of FVC, FVC% and FEV1 were significantly increased after hemodialysis. In terms of BIA parameters, patients’OH/ECW% after dialysis was statistically lower than that before dialysis (t value: 2.213, 2.389, 2.327 and 15.117, respectively，P value: 0.030,0.019, 0 .022 and＜0.001, respectively). Overhydration was seen in 15 patients (27.8%). The FVC, FVC%, FEV1, FEV1%, FEF25-75, FEF25-75%, PEFR and PEFR% in the overhydration group were all lower than those in the non-overhydration group, and the differences were statistically significant(t value: 4.740, 5.131, 4.902, 6.226, 4.263, 3.668, 2.904 and 3.694, respectively，P value:＜0.001,＜0.001,＜0.001,＜0.001, ＜0.001,＜0.001, 0.005 and＜0.001, respectively). OH/ECW was negatively correlated with FVC, FVC%, FEV1, FEV1%, FEF25-75, FEF25-75%, PEFR and PEFR% (r value:–0.411, –0.530, –0.395, –
0.491,–0.307,–0.272,–0.302and–0.425, respectively，P value: 0.002, ＜0.001, 0.003, ＜0.001, 0.024, 0.047, 0.027 and 0.001, respectively). Stepwise multiple linear regression model showed that increases in male and ultrafiltration were independently associated with higher FVC (Standard Beta value: 0.341 and 0.218 respectively，P value: 0.002 and 0.040 respectively), while increases in age and OH/ECW% were independently associated with lower FVC (Standard Beta value:–0.419 and -0.314 respectively, P value:＜0.001 and 0.002 respectively). Conclusion Overhydration is significantly related to respiratory dysfunction in ESRD patients who undergoing hemodialysis. Hemodialysis has a significant treatment to improve lung function, which may be due to the relief of overhydration after hemodialysis.

Key words: end- stage renal disease, hemodialysis, pulmonary function, fluid overload, bioimpedance analysis

中图分类号: