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目的:观察增加透析液流量(Qd)对维持性血液透析(MHD)患者透析充分性的影响。方法:随机选择稳定透析6个月以上的MHD患者38例。血透透析液流量定于500ml/min和800ml/min各透析4周,其他透析参数透析时间,血流量(Qb),超滤量和透析器型号与面积不变。每种Qd量于第3周和第4周分别测定透析前后血尿素氮(BUN)、血肌酐(SCr)水平,记录每次透析的透析时间、超滤量及透析后体重(W),并根据Kt/V的自然对数公式计算Kt/V、尿素下降率(URR),取2次测定值的平均值作为患者该透析液流量的Kt/V。同时检测第4周及第8周透析前的血红蛋白(Hb)和红细胞压积(Hct)水平。采用成对t检验和卡方检验进行统计学分析。结果:本研究中每例患者构成自身对照,研究前后一般情况完全一致。Qd为800ml/min时URR及Kt/V值均较Qd流量为500ml/min时增加,具有统计学意义(P<0·05),而SCr下降率、Hb和Hct水平略有增加趋势,无显著性差异。Qd为800ml/min时透析后URR>65%的百分数明显高于Qd为500ml/min时,具有显著统计学意义(P<0·001)。结论:将Qd从500ml/min增加至800ml/min,可显著增加URR、增加Kt/V,提高透析充分性达标率。800ml/min透析液流量的MHD可选择性用于不便于延长治疗时间和提高血流量达到透析充分性的患者。
Objective: To investigate the effect of increasing dialysate flow (Qd) on dialysis adequacy in maintenance hemodialysis (MHD) patients. Methods: Randomly selected 38 patients with stable MHD over 6 months. Hemodialysis dialysate flow rate set at 500ml / min and 800ml / min each dialysis for 4 weeks, other dialysis parameters dialysis time, blood flow (Qb), ultrafiltration volume and dialyzer type and area unchanged. The levels of blood urea nitrogen (BUN) and serum creatinine (SCr) were measured at the third week and the fourth week of each Qd. The dialysis time, the ultrafiltration volume and the weight after dialysis (W) were recorded. Calculate Kt / V based on the natural logarithm of Kt / V, the rate of urea drop (URR), and take the average of two determinations as the Kt / V of the patient’s dialysate flow. At the same time, the levels of hemoglobin (Hb) and hematocrit (Hct) before dialysis were detected at the 4th and 8th week. Paired t-test and chi-square test for statistical analysis. Results: Each patient in this study constituted a self-control, and the general situation before and after the study was exactly the same. When the Qd was 800ml / min, the URR and Kt / V values increased at a Qd of 500ml / min, with statistical significance (P <0.05), while the decreasing rates of SCr and Hb and Hct slightly increased Significant difference. The percentage of URR> 65% after dialysis at Qd of 800 ml / min was significantly higher than that at Qd of 500 ml / min (P <0.001). Conclusion: Increasing Qd from 500ml / min to 800ml / min can significantly increase URR, increase Kt / V, and improve the compliance rate of dialysis adequacy. The MHD at 800 ml / min dialysate flow is optionally used in patients who are inconvenient to prolong treatment time and increase blood flow to dialysis adequacy.