中国实用内科杂志2013，Vol.33Issue(8)：627-630,4.
在线血容量监测评估血液透析患者血容量超负荷诊断指标研究
Diagnostic value of on-line blood volume monitoring in evaluating the blood volume of hemodialystic patients
摘要
Abstract
Objective To study the diagnostic value of on-line relative blood volume(RBV) in evaluating the volume overload of hemodialystic patients.Methods We recruited 49 patients (23 males and 26 females)with end-stage renal disease (ESRD) who were on regular maintenance hemodialysis at the blood purificationcenter of the fourth affiliated hospital of the Hebei Medical University from August 2011 to January 2009.They all reached the DW under the clinical standard.Those 49 patients were divided into two groups based on their post-dialytic total body water(TBW) and the ratio of the extracellular fluid volume and the TBW (ECW/TBW％) measured by bioelectricity impedance.Those who met the normal values were designated group A(n =34) and the others group B(n =15).In group B,the DW was lowered by 0.2-0.5 kg per session until the TBW％,ECW/TBW％ reached the normal value,defined as group B.Meanwhile,changes in RBV were measured continuously during hemodialysis,using an on-line optical reflection method.Ultrafiltration rate(UFR),UFR index (UFRI,Ultrafiltration rate divided by the postdialysis weight),slopes of RBV (RBVS),volume index (VI,RBV slope corrected for UFR and postdialysis weight)were calculated.The UFRI,RBVS and VI were compared between group A and B,and between group A and B.Using receiver operating characteristic (ROC) curve,the areas under curves (AUCs) of the UFRI,BVMS,VI were calculated and compared with each other.Results All indexes except the UFRI were significantly higher in group A than in group B(P ＜0.01).However,no significant difference was noted between group A and B(P ＞0.05).The results of the AUC were as follows:VI 0.81 (95％ CI 0.67-0.90) ＞ BVMS 0.79 (95％ CI 0.65-0.90) ＞ UFRI 0.55 (95％ CI 0.40-0.69).Conclusion On-line relative blood volume serves as a good marker to monitor volume overload with higher specificity.VI lower than 0.22 suggests that dry weight canbe further lowered.However,the findings might require studies for validation,and their utility needs to be tested in clinical trials.关键词
血液透析/干体重/容量超负荷/在线血容量监测/生物电阻抗Key words
hemodialysis/dry weight/volume overload/continuous blood volume monitor/bioelectricity impedance分类
医药卫生引用本文复制引用
张慧然,徐金升,张俊霞,白亚玲,崔立文,周薇..在线血容量监测评估血液透析患者血容量超负荷诊断指标研究[J].中国实用内科杂志,2013,33(8):627-630,4.基金项目
河北省科技支撑计划项目(10276176) （10276176）
