维持性血液透析患者干体重控制的临床获益相关研究

发布时间：2018-02-27 15:45

本文关键词： 维持性血液透析干体重生物电阻抗　出处：《重庆医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：探讨维持性血液透析(MHD)患者干体重控制严格与非严格群体的差别,寻找干体重控制严格的患者所取得的临床获益。方法：选取2014年4月1日至2015年3月31日于重庆医科大学附属第二医院血液透析室规律血液净化治疗超过3个月的MHD患者98例。收集MHD患者近1月前应用人体成分分析仪所测得干体重与患者透析后所称取干体重值,根据患者两者之间相差绝对值所占人体成分分析仪所测得干体重的比率进行分组。所占比率小于0.5%患者划归为严格组,43例；所占比率大于0.5%患者划归为非严格组,55例。所有MHD患者空腹测定血红蛋白、血清钙离子、血清磷离子、全段甲状旁腺激素、血肌酐,统计各组患者的年龄、性别以及透析龄,记录干体重所测当日透析后体重、2015年3月份内6次透析前的收缩压(SBP)和舒张压(DBP)；观察患者近期3月内头昏眩晕、头痛、恶心呕吐、心累气促、夜间阵发性呼吸困难、皮肤瘙痒、纳差、水肿的发生情况,计算平均收缩压与平均舒张压。根据上述临床资料,比较两组患者之间存在的差别。结果：符合入选标准的患者有98人,其中男性56例(57.14%),女性42例(42.86%),年龄55.57±14.75(21～85)岁,透析龄38.96±28.16(5-128)月。入组患者终末期肾脏病病因为：慢性肾小球肾炎有47例(47.96%),糖尿病肾病有22例(22.45%),高血压肾损害有22例(22.45%),其他有7例(7.14%)。两组患者进行基本资料、临床症状、透析前收缩压、透析前舒张压、实验室指标(血红蛋白、血清钙离子、血清磷离子、全段甲状旁腺激素、血肌酐)的比较,结果提示透析前平均收缩压、透析前平均舒张压、Hb水平存在显著差异(P0.05)；恶心呕吐、心累气促、夜间阵发性呼吸困难、头痛、纳差、水肿方面的发生与干体重控制不理想密切相关(P0.05)。结论：严格控制干体重后患者在血压控制、贫血改善方面显著获益；并可降低心衰及消化道症状的发生；利用多频生物电阻抗法评估患者干体重是目前临床有效方法,有其临床应用价值。
[Abstract]:Objective: to explore the difference between strict and non-strict control of dry weight in patients with maintenance hemodialysis (MHD). Methods: from April 1st 2014 to March 31st 2015, regular hemodialysis room of the second affiliated hospital of Chongqing Medical University was selected for more than 3 months of regular hemodialysis treatment. The dry weight measured by body composition analyzer before January and the dry weight after dialysis were collected from 98 patients with MHD. According to the ratio of dry weight measured by the absolute value of the difference between the two patients, 43 cases were classified into strict group (43 cases), and the proportion of the patients less than 0.5% was classified into strict group (43 cases). All patients with MHD were assessed for hemoglobin, serum calcium ion, serum phosphorus ion, total parathyroid hormone, serum creatinine, age, sex and dialysis age. The body weight after dialysis, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded after dialysis on March 2015, and dizziness, headache, nausea and vomiting, heart dyspnea, paroxysmal dyspnea at night and itching of skin were observed in patients with dizziness, headache, nausea and vomiting during March. According to the above clinical data, the differences between the two groups were compared. Results: 98 patients met the inclusion criteria. Among them, 56 cases were male (57.14) and 42 cases (female) were 42.86 years old (55.57 卤14.75) years old. The age of dialysis was 38.96 卤28.165128months. The etiology of end-stage renal disease was 47 cases of chronic glomerulonephritis, 22 cases of diabetic nephropathy, 22 cases of hypertension kidney damage, 22 cases of hypertension kidney damage, and 7 cases of other 7 cases of renal disease. The comparison of systolic blood pressure before dialysis, diastolic blood pressure before dialysis, laboratory indexes (hemoglobin, serum calcium ion, serum phosphorus ion, whole segment parathyroid hormone, serum creatinine) showed that the mean systolic blood pressure before dialysis, There was significant difference in mean diastolic blood pressure before dialysis (P 0.05), nausea and vomiting, heart dyspnea, paroxysmal dyspnea at night, headache, anorexia, dyspnea, dyspnea, dyspnea, dyspnea, dyspnea, dyspnea, dy@@. The occurrence of edema is closely related to the poor control of dry weight (P0.05). Conclusion: after strict control of dry weight, the patients have significant benefits in blood pressure control and anemia improvement, and can reduce the incidence of heart failure and digestive tract symptoms. It is an effective clinical method to evaluate dry weight of patients by multi-frequency bioelectrical impedance method, which has clinical application value.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R459.5

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