中国血液净化

›› 2009, Vol. 8 ›› Issue (7): 375-378.

• 论著 • 上一篇    下一篇

多频生物电阻抗法评价血液透析患者体液分布

孙 芳 周亦伦 刘 婧 马丽洁 韩 彬 沈 洋 崔太根   

  1. 首都医科大学附属北京朝阳医院肾内科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2009-01-01 发布日期:2009-01-01

Assessment of fluid distribution in patients on maintenance hemodialysis by bio-impedance spectrum analysis

SUN Fang, ZHOU Yi-lun, LIU Jing, MA Li-jie, HAN Bin, SHEN Yang, CUI Tai-gen   

  1. Department of Nephrology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
  • Received:1900-01-01 Revised:1900-01-01 Online:2009-01-01 Published:2009-01-01

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摘要：

【摘要】目的 利用多频生物电阻抗测量法了解维持性血液透析(HD)患者体液分布情况。 方法 选择透析龄大于3个月的维持性HD患者119名，应用多频生物电阻抗频谱分析法分别于透析前、后测定细胞外液（ECW）、细胞内液（ICW），并分别计算占体重的百分比(ECW%、ICW%）。选择性别、年龄和体重相匹配个体82例作为正常对照。 结果 男性和女性维持性HD患者ECW%较同性别正常对照组明显增高（男P＜0.01，女P＜0.05），透析后较透析前显著降低(P＜0.01）；ICW%与同性别正常对照组无显著性差异（P＞0.05），且透析前、后无明显变化；男女患者ECW/ICW比值透析前均显著高于同性别正常对照组(P＜0.01），透析后虽较透析前显著降低(P＜0.01），但仍高于同性别正常对照组（P＜0.05）。HD患者透析过程ECW下降值与实际超滤量呈显著正相关（男r=0.572，P＜0.01；女r=0.556，P＜0.01）。同性别透析高血压组的ECW%透析前后均高于正常血压组和正常对照组（P＜0.05）；正常血压组透后ECW%与对照组无明显差异。高血压组和正常血压组ICW%在透析前、透析后与正常对照均无差别。 结论 ①透析前HD患者存在体液分布异常，主要表现为ECW%显著增加；②HD脱水主要来自细胞外液，对细胞内液无明显影响；③利用多频生物电阻抗测量透后ECW%可能是评价HD患者干体重的有效指标。

关键词: 血液透析, 生物电阻抗, 干体重, 细胞外液

Abstract:

【Abstract】 Objective To evaluate the fluid distribution in patients on maintenance hemodialysis by the whole-body bio-impedance spectroscopy. Methods A total of 119 patients with stable hemodialysis for more than 3 months were enrolled in this study. Pre- and post-dialysis intracellular water (ICW) and extracellular water (ECW) were measured by whole-body multi-frequency bio-impedance spectroscopy (Bodystat, UK), and standardized by body weight to produce ICW% and ECW%. Eighty-two normal individuals of matched sex, age and body weight were used as controls. Results Patients on maintenance hemodialysis had significantly higher ECW% and ECW/ICW ratio compared with normal controls (P＜0.01). ECW% and ECW/ICW ratio decreased significantly after hemodialysis, but were still higher than those of controls. By contrast, pre- and post-dialysis ICW% values in HD patients were similar to those of controls. Lower ECW after dialysis was positively correlated with ultrafiltration volume (r=0.572, P＜0.01 for males; r=0.556, P＜0.01 for females). Patients with hypertension had higher pre- and post-dialysis ECW% values than those without hypertension. In patients with normal blood pressure, post-dialysis ECW% was similar to that of controls. Conclusions Hemodialysis patients have higher pre-dialysis ECW%. Fluid ultrafiltration is mainly derived from extracellular water during hemodialysis. Post-dialysis ECW% may be a useful parameter for the evaluation of dry weight in HD patients.

Key words: Bio-impedance, Extracellular water, Dry weight

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