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在线尿素清除率监测仪检测透析充分性的准确性分析
Accuracy of Hemodialysis Adequacy Evaluated by Online Clearance Monitor
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DOI:
作者:
高嘉元
Gao Jia-yuan
作者单位:
上海交通大学医学院附属仁济医院 肾脏科
Renal division, Renji Hospital Shanghai Jiaotong University School of Medicine, Shanghai
关键词:
血液透析; 尿素清除指数; 在线尿素清除率; 透析液直接定量法;
Hemodialysis, Kt/V, Online clearance monitor, direct dialysate quantification
摘要:
目的 探讨在线尿素清除率监测仪(OCM)监测透析患者透析充分性的准确性及其应用价值。方法 19例行规律性血液透析的无尿患者于治疗开始后0.5小时、1小时、2小时、3小时、4小时分别留取部分收集法(PDC)及全部收集法(TDC)透析液样本,测尿素氮水平,检验PDC方法的精确性并计算直接定量法Kt/V (DDQ Kt/V);于治疗开始前、结束即刻、结束30分钟后采血测尿素氮并通过Daugirdas II公式计算单室Kt/V(Sp Kt/V),采用更接近双室水平的速率公式、平衡公式计算Ra Kt/V、Eq Kt/V,使用费森尤斯公司OCM模块监测Kt/V(OCM Kt/V),比较不同方法得到的Kt/V水平及其相关性;比较OCM内置Watson公式、Hume-Weyers公式、体重推导公式计算患者尿素分布容积(Vurea)与直接定量法计算获得的Vurea之间的差异。结果 PDC方法与TDC方法获得的样本尿素氮水平于各时间点上均无显著性差异,相关性检验和Bland-Altman检验均显示两者的一致性极好;OCM Kt/V、Ra Kt/V、Eq Kt/V 与DDQ Kt/V值均很接近(1.24±0.24、1.39±0.24、1.41±0.27 vs. 1.34±0.26,P值分别为0.21、0.55、0.40),而Sp Kt/V显著高于DDQ Kt/V(1.58±0.27 vs. 1.34±0.26,P<0.05)。OCM Kt/V、Sp Kt/V、Ra Kt/V、Eq Kt/V同DDQ Kt/V之间均存在显著相关,但 OCM Kt/V与DDQ Kt/V(r= 0.706,P<0.05)的相关性略低于Sp Kt/V、Ra Kt/V、Eq Kt/V与DDQ Kt/V的相关性(r值分别为0.901、0.891、0.963,P均<0.05);OCM三种内置公式得出的Vurea水平均显著高于DDQ计算水平(P<0.05)。 结论 OCM Kt/V与患者实际获得的透析剂量相似且存在良好的相关性,可能可以作为患者实际获得的透析剂量的一种较可靠测量方法,且可以实时监测,应进一步推广与验证。
Object To analyze the accuracy of hemodialysis adequacy evaluated by online clearance monitor (OCM), as well as the value of its application. Method 19 anuric maintenance hemodialysis patients were included in the study. Drained dialysate samples were collected at 0.5hr, 1hr, 2hr, 3hr and 4hr after the beginning of therapy by both partial dialysate collection method (PDC) and total dialysate collection method (TDC). Urea nitrogen levels were assessed to evaluate the agreement between PDC and TDC and calculate Kt/V by direct dialysate quantification method (DDQ, DDQ Kt/V). Blood urea nitrogen (BUN) at the beginning of dialysis, at the end of dialysis as well as 30 minutes after therapy were measured. Single pool Kt/V (Sp Kt/V) by Daugirdas II formula was calculated. Equilibrated Kt/V (Eq Kt/V) and rate adjusted Kt/V (Ra Kt/V), which seem close to double pool Kt/V, were also employed. OCM Kt/V was provided by OCM module from Fersenius. The value and correlation of Kt/V by different methods were analyzed. Urea distribution volume (Vurea) used in the three formulas internally installed in OCM were compared with the standard Vurea level from direct dialysate quantification. Result Urea nitrogen levels on different points showed no significant difference between PDC and TDC. Both correlation analysis and Bland-Altman analysis showed great agreement between two methods. The value of OCM Kt/V, Ra Kt/V and Eq Kt/V were similar with DDQ Kt/V (1.24±0.24, 1.39±0.24, 1.41±0.27 vs. 1.34±0.26, P values were 0.21, 0.55, 0.41, separately), while Sp Kt/V was significantly higher than DDQ Kt/V (1.58±0.27 vs. 1.34±0.26, P<0.05). Either OCM Kt/V, Sp Kt/V, Ra Kt/V or Eq Kt/V was well correlated with DDQ Kt/V. The relationship between OCM Kt/V and DDQ Kt/V (r= 0.706,P<0.05) was lower than that of Sp Kt/V, Ra Kt/V or Eq Kt/V (R values were 0.901, 0.891, 0.963, separately. both P<0.05). Vurea level calculated from all three OCM internally installed formulas was significantly (P<0.05) higher than DDQ. Conclusion The correlation between OCM Kt/V and DDQ Kt/V was ideal with pretty similar value. It may become a good method to evaluate the actual delivered dialysis dose for hemodialysis patients. The advantage of on-line quick monitoring suggests its further value in application, but need more validation.
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