摘要
目的 评价血液透析充分性的临床标准和尿素动力学模型 (UKM )参数 ,并观察透析后尿素反跳 (PDUR)对评价的影响。方法 按临床标准分为透析充分组 (Ⅰ组 )和透析不充分组 (Ⅱ组 ) ,分别计算PDUR以及反跳前后UKM参数即尿素清除指数 (Kt/V)、尿素时间平均浓度(TACurea)、蛋白分解率 (PCR)。结果 两组PDUR、尿量以及反跳前后的UKM参数存在显著性差异(P <0 .0 1) ;G S图显示Ⅱ组临床和参数判断基本一致 ,但Ⅰ组存在较大差异 ;平均PDUR为 17.8% ,反跳后的Kt/V、PCR值较反跳前分别下降 18.7%和 12 .7% ,而TACurea值增加 3 .1% ,PDUR与透析间尿量呈负相关 (r=-0 .64 )。结论 透析充分性评价是一连续非短期过程 ,宜综合临床和参数指标判断 ,以后者为主 ;忽视PDUR将高估透析充分性 ,宜用透析后尿素平衡浓度计算参数 ;透析不充分和残存肾功能可能影响PDUR程度。
Objective To compare the difference between the clinical standard and parameters of urea kinetic modeling (UKM),and to observe the effects of postdialysis urea rebound(PDUR) on evaluation of hemodialysis adequacy.Methods According to clinical standard of adequacy,27 chronic hemodialysis patients were divided into adequate (I) and inadequate (II) groups.Blood urea was tested at the different time to calculate UKM including Kt/V,time average concentration of urea (TACurea) and protein catabolic rate(PCR) before or after urea rebound and the extent of PDUR.Results The extent of PDUR,urine output,value of Kt/V,TACurea and PCR(P<0.01) were significantly different between both groups.G-S diagram showed that the clinical standard was approximately consistent with the parametric evaluation in group II,but not consistent in group I.The mean of PDUR was 17.81%.Kt/V and PCR were decrease by 18.7% and 12.7% after PDUR,but TACurea increase by 3.1%.PDUR was closely correlated with the urine output(r =-0.64).Conclusions It is necessary for evaluation of hemodialysis adequacy to implement integrated index including clinical standard and parameters,particularly the latter.The continuous observation needs to be emphasized.The parameters should be calculated according to the urea concentration equilibrized by postdialysis because neglecting PDUR can result in overestimating the adequacy.The extent of PDUR may be affected by the inadequacy and residual renal function.
出处
《临床内科杂志》
CAS
北大核心
2004年第6期412-414,共3页
Journal of Clinical Internal Medicine
