OCM对血液透析充分性评价的研究

摘要

Objective:To investigate the feasibility and accuracy of online clearance monitoring (OCM) in assessing hemodialysis adequacy.Method:Sixty patients with maintenance hemodialysis were investigated on OCM appliance,whose blood flow was 240~330 ml/min,dialysate flow was 500 ml/min.Meanwhile, blood urea nitrogen(BUN) of pre-and post-dialysis were examined and calculate Kt/v according to the equation Daugirdas.Then,the correlation was evaluated between Kt/V by OCM and by calculation.Kt/V by OCM and by calculation was also compared in the situations of different body weight,ultrafiltration volum. Result:Kt/V by OCM was (1.34±0.22),and by calculation was (1.39 ±0.23),the correlation coefficient of linear regression analysis,γ=0.813,(P<0.001). In group A (body weight≤60 kg) and group B(body weight>60 kg),the Kt/V value from OCM was (1.49±0.17) and (1.24±0.19).The value by calculation was (1.55±0.19) and (1.29±0.19)(P<0.05).The differences either by OCM or by calculation were statistically significant between the patients with ultrafiltration volume<3.5 kg and those≥3.5 kg.Conclusion:Correlation between Kt/V by OCM and by calculation was satisfactory.OCM could be applied in clinic widely.%目的：探讨在线尿素清除率监测(OCM)评估血液透析充分性的可行性和准确性。方法：随机选取规律血液透析患者60例，其中男性32例，女性28例，透析中血流量240~330 ml/min，透析液流量500 ml/min。利用OCM测得Kt/V值，同时透析前后取全血检测尿素氮浓度，根据单室尿素动力模型DaugirdasⅡ公式计算Kt/V值，比较两种方法的相关性及不同体重、超滤量对两者的影响。结果：患者OCM测得的Kt/V值为1.34±0.22，采血法测得的Kt/V值(1.39±0.23)，两者有显著性差异(t=2.81，P<0.001)，直线回归分析相关指数r=0.813，P<0.001，显示两者之间存在显著的相关性。将患者按体重分为≤60 kg、体重>60 kg两组，其中体重≤60 kg组两种方法测得的Kt/V均高于体重>60 kg组。将患者按超滤量分为<3.5 kg、≥3.5 kg组。两组Kt/V值无论采用OCM还是采血计算法比较差异有统计学意义(P<0.05)。结论：OCM与常规方法测得Kt/V值有较好的相关性，可以在临床广泛使用。