摘要
目的了解腹膜透析患者容量负荷状况及其对营养状况的影响。方法选取2010年1月—2012年1月在西安交通大学医学院第一附属医院腹膜透析中心门诊进行腹膜透析且时间超过3个月的患者177例为研究对象。按照患者的水肿程度分为4组,A组110例,无水肿;B组38例,有轻度水肿;C组22例,有中度水肿;D组7例,有重度水肿。比较各组患者的体质量增加量、尿量、超滤量、血压、透析液平均浓度、24 h腹透液蛋白丢失量、血清清蛋白、血糖、C反应蛋白水平。用主观全面营养评估(SGA)方法对患者的营养状况进行评价,比较4组营养不良发生率。结果 4组患者的年龄(P=0.391),透析充分性(P=0.135)、肾小球滤过率(P=0.187)及尿量(P=0.204)间差异均无统计学意义。4组患者的体质量增加量、超滤量、液体总出量、收缩压水平间差异均有统计学意义(P<0.05)。D组患者体质量增加量、超滤量、收缩压水平明显高于A、B、C组,液体总出量、24 h腹透液蛋白丢失量高于A、B组,清蛋白水平低于其他3组,差异均有统计学意义(P<0.05);D组使用透析液平均浓度及血糖水平明显高于其他3组,差异有统计学意义(P<0.05);D组患者的C反应蛋白水平明显高于其他3组,营养不良的发生率也明显高于其他3组,差异均有统计学意义(P<0.05)。结论容量负荷增多的腹膜透析患者血压增高,营养状况恶化。容量超负荷产生微炎症状态可能是导致营养不良的原因之一。控制容量可能改善患者高血压和营养不良,但通过使用高糖透析液来增加超滤量,可能加重糖代谢紊乱,使容量更加难以控制。
Objective To analyze the effect of volume load on nutrition status in patients receiving peritoneal dialysis （PD）. Methods A total of 177 patients having received PD for over 3 months were divided, according to degree of edema, in- to groups A （n=110, without edema）, B （n=38, with mild edema） , C （n=22, with moderate edema）, D （n =7, with severe edema）. The changes of body weight （BW）, urine output, mount of ultrafiltration, blood pressure （BP）, average concentration of dialysate, 24 h protein loss of dialysate, albumin, blood glucose （BG）, C -reactive protein （CRP） were eval- uated by subjective global assessment （SGA） and the incidences of malnutrition compared in 4 groups. Results No significant difference was noted in age （P =0. 391 ）, dialysis adequacy （P =0. 135）, glomerular filtration rate （P =0. 187）, urine output （P = 0. 204） in 4 groups. There was difference in BW increases, amount of ultrafihration, total amount of liquid, SBP （P 〈 0. 05）. D group were higher than groups A, B, C in BW increases, amount of ultrafiltration, SBP, higher than groups A, B in total amount of liquid, 24 h protein loss of dialysate, lower than groups A, B, C in albumin, the difference was significant （ P 〈 0. 05 ）. D group were higher than groups A, B, C in average concentration of dialysate and BG, the difference was signifi- cant （P 〈 0. 05 ）, higher in CRP and incidence of malnutrition （P 〈 0. 05 ）. Conclusion Increase of volume load of PD pa- tients leads to rise of BP and deterioration of nutritional status. Microinflammation due to volume overload may be one of the rea- sons causing malnutrition. Control of volume may improve hypertension and malnutrition, but using high glucose dialysate to in- crease uhrafiltration may aggravate disorders of glucose metabolism to make it more difficult to control volume.
出处
《中国全科医学》
CAS
CSCD
北大核心
2013年第14期1655-1657,共3页
Chinese General Practice
关键词
腹膜透析
容量负荷
营养
微炎症
Peritoneal dialysis
Volume overload
Malnutrition
Micro - inflammation
