维持性血液透析患者透析过程中细胞内外液变化规律

摘要

目的 利用生物电阻抗分析法(bioimpedence analysis,BIA)探究血液透析患者透析过程中细胞内外液的变化规律. 方法 选取接受维持性血液透析(maintenance hemodialysis,MHD)治疗的患者55人,利用生物电阻抗仪测试每位受试者透析前、透析中第1h、2h、3h、4h这5个时间点的总体液(total body water,TBW)、细胞内液(intracellular water,EW)和细胞外液(extracellular water,ECW). 结果 ①透析过程中细胞内液、细胞外液均下降,且细胞内液下降量大于细胞外液;②患者体内剩余的细胞内液与细胞外液的比值在透析中的第1h、2h时基本保持在2:1的比例,与透析前相比无显著性差异(t=-5.620,P=0.580;t=-2.048,p=0.053),而第3h、4h时,比值略微升高,达到2.1:1,(F-3.269,P=0.030;t=-4.696,P＜0.001)③透析中的第1、2、3、4小时,△1ICW/△ECW比值分别为:1.9、1.8、1.5、1.4,且第4h比第1h显著降低(t=2.279,P=O.036);④透析结束后细胞内液下降率为5.4％,细胞外液下降率为8.4％,二者具有显著性差异(t=3.994,P＜0.001). 结论 ①透析过程中患者超滤脱水不仅来自于细胞外液,还来自于细胞内液,且细胞内液脱水多于细胞外液,体内剩余的细胞内外液比例略微升高.②在透析过程中,细胞内液脱水量与细胞外液脱水量的比值随着时间的推移逐渐减小,细胞内液下降率小于细胞外液下降率.这提示:透析过程中超滤的多余水分是细胞内液通过细胞膜渗透到细胞外液,随同细胞外液一起脱出体外.%Objective This study aimed to explore the regularity of intracellular and extracellular water changes in maintenance hemodialysis (MHD) patients during dialysis.Methods We selected 55 MHD patients as the subjects and measured their total body water (TBW),intracellular water (ICW) and extracellular water (ECW) before dialysis and every hour during dialysis,i.e.,a total of 5 measurements for a patient.Resuits ①Both ICW and ECW decreased during dialysis as compared with those before dialysis,and ICW decreased more than ECW.②The ratio of ICW/ECW was 2∶1 in the first two hours during the dialysis,without significant difference with that before dialysis (t=-5.620,P=0.580;t=-2.048,P=0.053);the ratio increased slightly to 2.1∶1 in the last two hours during the dialysis (t=-3.269,P=0.030;t=-4.696,P ＜0.001).③The ratios of △ICW/△ECW were 1.9,1.8,1.5 and 1.4 at the 1st,2nd,3rd and 4th hour respectively during the dialysis,and this ratio decreased significantly at the 4th hour as compared with that at the 1 st hour (t=2.279,P=0.036).④After dialysis,the reduction rate of ICW and ECW were 5.4％ and 8.4％ respectively (t=3.994,P＜0.001).Conclusion ①Dialysis by ultrafiltration decreased the water retention in both extracellular and intracellular spaces,and the intracellular water decreased more than the extracellular water,resulting in slight increase of ICW/ECW ratio at the end of dialysis.②The ratio of △ICW/△ECW decreased gradually along with the hour of the dialysis,and the reduction rate of ICW was less than that of ECW,suggesting that the excessive water in intracellular space moves to extracellular space through osmotic gradient and removes from the body with ECW during dialysis.