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目的了解血液透析(HD)患者透析前后体液的分布状况及其对血压的影响。方法106例健康志愿者作为正常对照,按性别分为组用生物电阻抗频谱法检测并计算细胞外2,液(ECV)、细胞内液(ICV)占体重的百分比(ECV%、ICV%)和ECV/ICV比值。选择我院透析龄月2以上的稳定HD患者67例,按照透析前后血压状况将患者分为低血压倾向组、正常血压组、普通高血压组和顽固性高血压组,分别于透析前和透析后测量体重、ECV、ICV,并计算ECV%、ICV%和ECV/ICV比值。ECV、ICV采用电生物阻抗分析仪测定。结果HD患者ECV%、ECV/ICV透后较透前下降,而ICV%上升;透前ECV%、ECV/ICV明显高于正常对照,透后接近正常人群水平。顽固性高血压患者(均为男性)透后ECV%仍明显高于正常对照水平[(31.6±1.0)%比(25.3±1.6)%,P<0.01],而低血压倾向患者均为女性在透析前()ECV%即与正常对照水平无明显差异[(21.6±1.5)%比(22.6±1.4)%,P>0.05],透后明显低于正常对照水平[(19.3±1.6)%比(22.6±1.4)%,P<0.01]。结论HD患者水分布与正常人相比存在着明显不同,表现为ECV%增加和ICV%减少,而血液透析通过脱水和水分向细胞内转移部分纠正了这种异常。ECV%反映了HD患者水负荷的情况,并与血压之间存在着密切的关系。
Objective To understand the distribution of body fluid before and after dialysis in hemodialysis (HD) patients and its effect on blood pressure. Methods A total of 106 healthy volunteers were selected as normal controls and divided into groups according to sex. The bioelectrical impedance spectroscopy was used to detect the percentage of ECV and ICV in ECV and ICV% And ECV / ICV ratio. Sixty-seven patients with stable HD were enrolled in our study. All patients were divided into two groups: hypotensive group, normotensive group, general hypertensive group and refractory hypertension group according to the blood pressure before and after dialysis. Body weight, ECV and ICV were measured and ECV%, ICV% and ECV / ICV were calculated. ECV, ICV using the bioelectrical impedance analyzer. Results After HDV, the ECV% and ECV / ICV of HD patients were lower than those of the control group, while the ICV% of the HD patients increased. The levels of ECV% and ECV / ICV before HD were significantly higher than those of the normal control group and close to the normal level. ECV% of patients with refractory hypertension (all men) was still significantly higher than that of the control ([31.6 ± 1.0]% vs (25.3 ± 1.6)%, P <0.01], while those with hypotension were all female Before dialysis, ECV% had no significant difference with normal control [(21.6 ± 1.5)% vs (22.6 ± 1.4)%, P> 0.05], and was significantly lower than that of normal control [(19.3 ± 1.6)% vs (22.6 ± 1.4)%, P <0.01]. Conclusions There is a significant difference in water distribution between patients with HD and normal subjects, with an increase in ECV% and a decrease in ICV%, whereas hemodialysis corrects this abnormality partially through dehydration and moisture transfer to intracellular metastases. ECV% reflects the water load in patients with HD, and there is a close relationship between blood pressure.