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透析患者容量负荷状态的监测与评估

Volume load monitoring and evaluation of dialysis patients

  • 摘要: 透析患者普遍存在容量超负荷,但透析过程中液体清除过多又会负荷过低,影响透析质量。临床上通常根据患者血压、中心静脉压、水肿程度、皮肤弹性等症状体征评估透析患者的容量负荷,虽简便易行,但可靠性差。同位素稀释法是评估患者容量负荷状态的金标准,但需要患者摄入同位素,评估方法复杂、可行性差,难以在临床大规模应用。近年来下腔静脉内径测量、肺超声、生物电阻抗测量、血清标志物方法检测等广泛应用于临床工作。本文总结了临床常用的评估透析患者容量负荷状态的方法及其有效性、适用性和局限性。

     

    Abstract: Dialysis patients generally have volume overload, but excessive liquid removal can result in low volume load, affecting the quality of dialysis. Volume load is usually evaluated by blood pressure, central venous pressure, edema state, skin elasticity, and other symptoms, although these methods are simple and feasible, the reliability is relatively poor. Isotopic dilution is the gold standard for assessing the volume load, but patients need to uptake the isotope, the evaluation method is complicated and has poor feasibility, therefore is difficult to be applied in clinical. In recent years, inferior vena cava diameter measurement, lung ultrasound, bioelectric impedance measurement, and serum marker methods were widely used in clinical settings. This paper reviews the methods of evaluating the volume load of dialysis patients and the validity, applicability, and limitation of the existing methods.

     

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