血流量大小对带cuff中心静脉导管血液透析患者透析充分性的影响

摘要

目的 观察血流量大小对带cuff中心静脉导管血液透析患者透析充分性的影响.方法 将15例带cuff中心静脉导管维持血液透析患者的血流量设为200ml/min,透析12次后再设为250ml/ min,透析12次后进入洗脱期,设为200ml/min透析24次,再设为300ml/min透析12次.每次透析 4h,每周3次.观察每种血流量时的单室模型Kt/V(spK t/V)、尿素清除率(URR),观察试验前、后血红蛋白、红细胞压积、心功能的变化.结果 随着血流量的增加,spKt/V和URR值越高,透析越充分.血流量分别为200ml/min、250ml/min、300ml/min时的spK t/V值分别为(1.44±0.04)、(1.58±0.05)、(1.85±0.20)(1.44 比 1.58,1.44 比 1.85,均P＜0.05),URR值分别为(69.01%±3.88%)、972.23%±4.26%)、(76.06%±4.82%) (69.01% 比 72.23%,69.01% 比 76.06%,均P＜0.05).试验后的血红蛋白和血红细胞压积较试验前增加(107.60g/L 比 92.20g/L,31.65fl 比 28.53fl,均P ＜ 0.05).试验前后的射血分数EF%、每搏输出量(SV)、心室舒张末期容积(EDV)、心室收缩末期容积(ESV) 的差异均没有统计学意义(均P >0.05).结论 带cuff中心静脉导管血液透析患者随着血流量的增加,透析越来越充分,不会对心功能产生明显不良影响,且可以改善贫血状况.%Objective To evaluate the influence of blood flow on hemodialysis adequacy in patients with cuffed central venous catheters. Methods Fifteen stable patients on thrice-weekly maintenance hemodialysis and with cuffed central venous catheters were enrolled in this study. Their blood flow in hemodialysis was first held constant at 200ml/min for 4 hours in each hemodialysis session for 12 dialysis sessions, and was then changed to 250ml/min for another 12 dialysis sessions. After that, the blood flow was changed back to 200ml/min for 24 dialysis sessions, and then increased to 300ml/min for another 12 sessions. The objectives of this study were to observe the dialysis adequacy based on the parameters of single pool urea kinetics (spKt/V) and urea reduction ratio (URR), and to observe the alterations of hemoglobin, hematocrit and heart function under different blood flow protocols. Results spKt/V and URR became higher when blood flow increased. When the blood flow was set at 200ml/min, 250ml/min and 300ml/min, spKt/V was 1.44 ± 0.04, 1.58 ± 0.05 and 1.85 ± 0.20, respectively (1.44vs. 1.58, and 1.44 vs. 1.85, P ＜0.05), and URR was 69.01 ± 3.88％, 72.23 ± 4.26％ and 76.06 ± 4.82％, respectively (69.01％ vs. 72.23％, and 69.01％ vs. 76.06％, P ＜0.05). Hemoglobin and hematocrit increased after the study (92.20g/L vs.107.60g/L, and 28.53fl vs. 31.65fl; P ＜ 0.05). Ejection fraction, stroke volume, end diastolic volume and end systolic volume were statistically indifferent before and after the study (P＞0.05). Conclusions Increase of blood flow for hemodialysis may result in the increase of dialysis efficiency with stable heart function and improvement of anemia in patients with cuffed central venous catheters.