本文關(guān)鍵詞： 維持性血液透析 干體重 生物電阻抗　出處：《重慶醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：探討維持性血液透析(MHD)患者干體重控制嚴格與非嚴格群體的差別,尋找干體重控制嚴格的患者所取得的臨床獲益。方法：選取2014年4月1日至2015年3月31日于重慶醫(yī)科大學(xué)附屬第二醫(yī)院血液透析室規(guī)律血液凈化治療超過3個月的MHD患者98例。收集MHD患者近1月前應(yīng)用人體成分分析儀所測得干體重與患者透析后所稱取干體重值,根據(jù)患者兩者之間相差絕對值所占人體成分分析儀所測得干體重的比率進行分組。所占比率小于0.5%患者劃歸為嚴格組,43例；所占比率大于0.5%患者劃歸為非嚴格組,55例。所有MHD患者空腹測定血紅蛋白、血清鈣離子、血清磷離子、全段甲狀旁腺激素、血肌酐,統(tǒng)計各組患者的年齡、性別以及透析齡,記錄干體重所測當日透析后體重、2015年3月份內(nèi)6次透析前的收縮壓(SBP)和舒張壓(DBP)；觀察患者近期3月內(nèi)頭昏眩暈、頭痛、惡心嘔吐、心累氣促、夜間陣發(fā)性呼吸困難、皮膚瘙癢、納差、水腫的發(fā)生情況,計算平均收縮壓與平均舒張壓。根據(jù)上述臨床資料,比較兩組患者之間存在的差別。結(jié)果：符合入選標準的患者有98人,其中男性56例(57.14%),女性42例(42.86%),年齡55.57±14.75(21～85)歲,透析齡38.96±28.16(5-128)月。入組患者終末期腎臟病病因為：慢性腎小球腎炎有47例(47.96%),糖尿病腎病有22例(22.45%),高血壓腎損害有22例(22.45%),其他有7例(7.14%)。兩組患者進行基本資料、臨床癥狀、透析前收縮壓、透析前舒張壓、實驗室指標(血紅蛋白、血清鈣離子、血清磷離子、全段甲狀旁腺激素、血肌酐)的比較,結(jié)果提示透析前平均收縮壓、透析前平均舒張壓、Hb水平存在顯著差異(P0.05)；惡心嘔吐、心累氣促、夜間陣發(fā)性呼吸困難、頭痛、納差、水腫方面的發(fā)生與干體重控制不理想密切相關(guān)(P0.05)。結(jié)論：嚴格控制干體重后患者在血壓控制、貧血改善方面顯著獲益；并可降低心衰及消化道癥狀的發(fā)生；利用多頻生物電阻抗法評估患者干體重是目前臨床有效方法,有其臨床應(yīng)用價值。
[Abstract]:Objective: to explore the difference between strict and non-strict control of dry weight in patients with maintenance hemodialysis (MHD). Methods: from April 1st 2014 to March 31st 2015, regular hemodialysis room of the second affiliated hospital of Chongqing Medical University was selected for more than 3 months of regular hemodialysis treatment. The dry weight measured by body composition analyzer before January and the dry weight after dialysis were collected from 98 patients with MHD. According to the ratio of dry weight measured by the absolute value of the difference between the two patients, 43 cases were classified into strict group (43 cases), and the proportion of the patients less than 0.5% was classified into strict group (43 cases). All patients with MHD were assessed for hemoglobin, serum calcium ion, serum phosphorus ion, total parathyroid hormone, serum creatinine, age, sex and dialysis age. The body weight after dialysis, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded after dialysis on March 2015, and dizziness, headache, nausea and vomiting, heart dyspnea, paroxysmal dyspnea at night and itching of skin were observed in patients with dizziness, headache, nausea and vomiting during March. According to the above clinical data, the differences between the two groups were compared. Results: 98 patients met the inclusion criteria. Among them, 56 cases were male (57.14) and 42 cases (female) were 42.86 years old (55.57 鹵14.75) years old. The age of dialysis was 38.96 鹵28.165128months. The etiology of end-stage renal disease was 47 cases of chronic glomerulonephritis, 22 cases of diabetic nephropathy, 22 cases of hypertension kidney damage, 22 cases of hypertension kidney damage, and 7 cases of other 7 cases of renal disease. The comparison of systolic blood pressure before dialysis, diastolic blood pressure before dialysis, laboratory indexes (hemoglobin, serum calcium ion, serum phosphorus ion, whole segment parathyroid hormone, serum creatinine) showed that the mean systolic blood pressure before dialysis, There was significant difference in mean diastolic blood pressure before dialysis (P 0.05), nausea and vomiting, heart dyspnea, paroxysmal dyspnea at night, headache, anorexia, dyspnea, dyspnea, dyspnea, dyspnea, dyspnea, dyspnea, dy@@. The occurrence of edema is closely related to the poor control of dry weight (P0.05). Conclusion: after strict control of dry weight, the patients have significant benefits in blood pressure control and anemia improvement, and can reduce the incidence of heart failure and digestive tract symptoms. It is an effective clinical method to evaluate dry weight of patients by multi-frequency bioelectrical impedance method, which has clinical application value.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R459.5

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