中国血液净化

›› 2011, Vol. 10 ›› Issue (9): 475-478.doi: 10.3969/j.issn.1671-4091.2011.09.00

• 临床研究 • 上一篇    下一篇

血流量大小对带cuff中心静脉导管血液透析患者透析充分性的影响

汤 锋 周巧巧 李凤娥 王 革 贺 欣 张 萍 杨丽南   

  1. 中国人民解放军第452医院肾内科
  • 收稿日期:2011-04-10 修回日期:1900-01-01 出版日期:2011-09-12 发布日期:2011-09-12
  • 通讯作者: 周巧巧

Influence of blood flow on hemodialysis adequacy in patients with cuffed central venous catheters

TANG Feng, ZHOU Qiao-qiao, LI Feng'e, WANG Ge, HE Xin, ZHANG Ping, YANG Lin-an   

  1. Department of Nephrology, the 452th Hospital of PLA, Chendu 610061, China
  • Received:2011-04-10 Revised:1900-01-01 Online:2011-09-12 Published:2011-09-12

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摘要：

目的 观察血流量大小对带cuff中心静脉导管血液透析患者透析充分性的影响。 方法 将15例带cuff中心静脉导管维持血液透析患者的血流量设为200ml/min，透析12次后再设为250ml/min，透析12次后进入洗脱期，设为200ml/min透析24次，再设为300ml/min透析12次。每次透析4h，每周3次。观察每种血流量时的单室模型Kt/V(spKt/V)、尿素清除率(URR)，观察试验前、后血红蛋白、红细胞压积、心功能的变化。 结果 随着血流量的增加，spKt/V和URR值越高，透析越充分。血流量分别为200ml/min、250ml/min、300ml/min时的spKt/V值分别为(1.44±0.04)、(1.58±0.05)、(1.85±0.20 )(1.44 vs 1.58, 1.44 vs 1.85，均P＜0.05)，URR值分别为(69.01%±3.88%)、972.23%±4.26%)、(76.06%±4.82%) (69.01% vs 72.23%, 69.01% vs 76.06%，均P＜0.05)。试验后的血红蛋白和血红细胞压积较试验前增加(107.60g/L vs 92.20g/L，31.65fl vs 28.53fl，均P＜0.05)。试验前后的射血分数EF%、每搏输出量(SV)、心室舒张末期容积(EDV)、心室收缩末期容积(ESV)的差异均没有统计学意义(均P>0.05)。 结论 带cuff中心静脉导管血透患者随着血流量的增加，透析越来越充分，不会对心功能产生明显不良影响，且可以改善贫血状况。

关键词: 血液透析, 带cuff中心静脉导管, 血流量, 透析充分性

Abstract:

Objective To evaluate the influence of blood flow on hemodialysis adequacy in patients with cuffed central venous catheters. Methods Fifteen stable patients on thrice-weekly maintenance hemodialysis and with cuffed central venous catheters were enrolled in this study. Their blood flow in hemodialysis was first held constant at 200ml/min for 4 hours in each hemodialysis session for 12 dialysis sessions, and was then changed to 250ml/min for another 12 dialysis sessions. After that, the blood flow was changed back to 200ml/min for 24 dialysis sessions, and then increased to 300ml/min for another 12 sessions. The objectives of this study were to observe the dialysis adequacy based on the parameters of single pool urea kinetics (spKt/V) and urea reduction ratio (URR), and to observe the alterations of hemoglobin, hematocrit and heart function under different blood flow protocols. Results spKt/V and URR became higher when blood flow increased. When the blood flow was set at 200ml/min, 250ml/min and 300ml/min, spKt/V was 1.44±0.04, 1.58±0.05 and 1.85±0.20, respectively (1.44 vs. 1.58, and 1.44 vs. 1.85, P＜0.05), and URR was 69.01±3.88%, 72.23±4.26% and 76.06±4.82%, respectively (69.01% vs. 72.23%, and 69.01% vs. 76.06%, P＜0.05). Hemoglobin and hematocrit increased after the study (92.20g/L vs.107.60g/L, and 28.53fl vs. 31.65fl; P＜0.05). Ejection fraction, stroke volume, end diastolic volume and end systolic volume were statistically indifferent before and after the study (P>0.05). Conclusions Increase of blood flow for hemodialysis may result in the increase of dialysis efficiency with stable heart function and improvement of anemia in patients with cuffed central venous catheters.

Key words: Cuffed central venous catheters, Blood flow, Dialysis adequacy