摘要
目的:观察增加透析液流量(Qd)对维持性血液透析(MHD)患者透析充分性的影响。方法:随机选择稳定透析6个月以上的MHD患者38例。血透透析液流量定于500ml/min和800ml/min各透析4周,其他透析参数透析时间,血流量(Qb),超滤量和透析器型号与面积不变。每种Qd量于第3周和第4周分别测定透析前后血尿素氮(BUN)、血肌酐(SCr)水平,记录每次透析的透析时间、超滤量及透析后体重(W),并根据Kt/V的自然对数公式计算Kt/V、尿素下降率(URR),取2次测定值的平均值作为患者该透析液流量的Kt/V。同时检测第4周及第8周透析前的血红蛋白(Hb)和红细胞压积(Hct)水平。采用成对t检验和卡方检验进行统计学分析。结果:本研究中每例患者构成自身对照,研究前后一般情况完全一致。Qd为800ml/min时URR及Kt/V值均较Qd流量为500ml/min时增加,具有统计学意义(P<0·05),而SCr下降率、Hb和Hct水平略有增加趋势,无显著性差异。Qd为800ml/min时透析后URR>65%的百分数明显高于Qd为500ml/min时,具有显著统计学意义(P<0·001)。结论:将Qd从500ml/min增加至800ml/min,可显著增加URR、增加Kt/V,提高透析充分性达标率。800ml/min透析液流量的MHD可选择性用于不便于延长治疗时间和提高血流量达到透析充分性的患者。
Objective ：To investigate the effects of dialysate flow rate （Qd） on dialysis adequacy in patients with maintenance hemodialysis （MHD） prospectively. Methodology.. Thirty-eight MHD patients were randomly selected in this study. The hemodialysis was performed at Qds of 500 and 800 ml/min for 4 weeks in every patient, whereas dialysis prescriptions （dialysis time, blood flow rate [ Qb], uhrafihration volume, and type and size of dialyzer） were kept constant. The delivered dose of dialysis, assessed by LnKt/V, was measured two times in the third and the fourth week at each Qd. Then the mean value was recorded as the Kt/V for this Qd. Meanwhile, hemoglobin （Hb） and hematocrit （Hct） was measured at the last week at each Qd. Results：Each patient was self-control. There were no differences in general state of each patient before and after the study. The urea reduction ratio （URR） and Kt/V increased significantly by increasing Qd from 500ml/min to 800 ml/min （P 〈0. 05）. There was an incremental tendency in the rate of SCr reduction and the level of Hb and Hct, but there was no significance（P 〉 0.05 ）. The proportion of patients achieving URR 〉 65% was increased from 42. 1% at Qd of 500 ml/min to 68.4% at 800 mL/min （ P 〈 0.001 ）. Conclusion： It is concluded that increasing Qd from 500 to 800 ml/min is associated with an increase in URR, Kt/V and the percentage of achieving dialysis adequacy. The hemodialysis with Qd of 800 ml/min may be considered in selected patients not achieving adequacy despite extended treatment times and optimized Qbs.
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
2006年第5期434-437,共4页
Chinese Journal of Nephrology,Dialysis & Transplantation
