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目的对新进入维持性血液透析(MHD)治疗的患者进行液体平衡管理,观察其残余肾功能(RRF)的保护情况。方法对74例新进入MHD治疗的患者进行前瞻性的液体平衡管理,随访12个月,对比随访前后患者残余尿量、透析除水量、血压控制、透析充分性、心胸比、左室重量指数(LVMI)等临床参数,记录不良事件,分析终点事件发生的相关因素;随访末分析保护RRF失败的危险因素。结果平均随访时间(10.1±2.3)月,发生终点事件10例(13.5%),RRF保护失败共计19例(25.7%),有效55例(74.3%)。与基线资料相比,随访末患者24h尿量[(1495.8±346.6)ml对(903.3±380.0)ml,P<0.001]和尿肌酐清除率明显下降[(3.92±1.34)ml/min·1.73m2对(2.33±1.10)ml/min·1.73m2,P<0.001];血压达标率升高(52.7%对71.6%,P=0.018),舒张压明显改善[(82.7±11.6)mmHg对(79.5±10.4)mmHg,P=0.039],但降压药DDD明显增高(1.82±0.29对1.96±0.53,P=0.035);患者单次透析最大除水量明显减少[(2.90±0.65)L对(2.69±0.76)L,P=0.015];心胸比[(0.50±0.04)ml对(0.48±0.04)ml,P<0.001]和LVMI[(130.1±12.0)g/m2对(117.5±12.3)g/m2,P<0.001]明显减小,差异均有统计学意义。Logistic回归显示糖尿病、随访末透析前收缩压高、随访末最大除水量是RRF保护失败的独立危险因素。结论对新进入MHD的患者开展容量控制管理可以有效保护其RRF。
OBJECTIVE To evaluate the balance of residual fluid function (RRF) in patients undergoing maintenance hemodialysis (MHD) treatment. Methods A total of 74 patients with MHD were enrolled in this study. The patients were followed up for 12 months. The residual urine volume, dialysate removal, blood pressure control, dialysis adequacy, cardiothoracic ratio, left ventricular mass index LVMI) and other clinical parameters, record adverse events, analyze the relevant factors of the end point events; at the end of follow-up analysis of risk factors to protect RRF failure. Results The mean follow-up time was 10.1 ± 2.3 months. Ten patients (13.5%) had end-point events. There were 19 (25.7%) and 55 (74.3%) patients failed to protect from RRF. Compared with the baseline data, at the end of the follow-up period, the urinary output of 24h patients (1495.8 ± 346.6 ml vs 903.3 ± 380.0 ml, P <0.001) and urinary creatinine clearance decreased significantly (3.92 ± 1.34 ml / min and 1.73 m2 (2.73 ± 1.10) ml / min · 1.73m2, P <0.001]. The blood pressure compliance rate was increased (52.7% vs 71.6%, P = 0.018) and the diastolic blood pressure was significantly improved (82.7 ± 11.6 mmHg vs 79.5 ± (2.90 ± 0.65) L vs. (2.69 ± 0.65) L, P <0.05), but the DDD of antihypertensive drugs was significantly higher (1.82 ± 0.29 vs. 1.96 ± 0.53, P = 0.035) P <0.001) and LVMI [(130.1 ± 12.0) g / m2 vs (117.5 ± 12.3) g / m2 , P <0.001] was significantly reduced, the differences were statistically significant. Logistic regression showed that the systolic blood pressure before dialysis was high at the end of follow-up. The maximum amount of water removed at the end of follow-up was an independent risk factor for RRF failure. Conclusions Volumetric management of patients newly recruited to MHD can effectively protect their RRF.