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目的观察在多频生物电阻抗法指导下调节干体重(DBW)对血液透析患者血压及透析相关并发症的影响。方法应用多频生物电阻抗分析仪测量细胞外液(ECW)。根据同性别正常对照组的ECW值确定正常参考范围。对ECW增高(提示容量过负荷)者,逐步降低DBW,观察ECW和血压的变化。对ECW降低(提示容量不足)者,逐步升高DBW,观察ECW、血压及透析相关并发症的影响。结果 ECW增高者降低DBW后,透析间期男性收缩压从(165±15)mmHg下降至(142±10)mmHg(P<0.01);女性收缩压从(160±7)mmHg下降至(138±6)mmHg(P<0.01),且未增加透析相关并发症。ECW降低者升高DBW后,透析相关并发症减少,而ECW和血压无明显变化。结论多频生物电阻抗法相对准确、稳定,与临床表现有良好相关性,有助于维持性血液透析患者干体重的调节,改善容量相关高血压并减少透析相关并发症的发生。
Objective To observe the effects of dry weight (DBW) regulation on blood pressure and dialysis-related complications in hemodialysis patients under the guidance of multi-frequency bioelectrical impedance. Methods Multi-frequency bioelectrical impedance analyzer was used to measure extracellular fluid (ECW). The normal reference range was determined based on the ECW value of the same sex normal control group. Increase in ECW (suggesting volume overload), and gradually reduce DBW, ECW and observed changes in blood pressure. For ECW reduction (indicating lack of capacity), the DBW was gradually increased to observe the effect of ECW, blood pressure and dialysis-related complications. Results After DBW was increased, the systolic pressure of male patients in dialysis interval decreased from (165 ± 15) mmHg to (142 ± 10) mmHg (P <0.01), and the systolic pressure decreased from (160 ± 7) mmHg to (138 ± 6) mmHg (P <0.01), and did not increase dialysis-related complications. There was no significant difference in dialysis-related complications but ECW and blood pressure after DBW was increased in ECW-lowering subjects. Conclusion The multi-frequency bioelectrical impedance method is relatively accurate and stable, and has good correlation with clinical manifestations. It is helpful to regulate the dry weight of maintenance hemodialysis patients, improve capacity-related hypertension and reduce the incidence of complications related to dialysis.