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題名 | Adjustment of Dry Weight by Extracellular Volume to Improve Blood Pressure Control and Reduce Dialysis Complications in Hemodialysis Patients=由細胞外體積調整乾體重以改善血液透析病人的血壓控制和併發症 |
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作者 | 陳幸復; 陳逸洲; 陳漢湘; 葉瑞圻; | 書刊名 | 臺灣腎臟醫學會雜誌 |
卷期 | 17:1 2003.03[民92.03] |
頁次 | 頁17-24+51 |
分類號 | 415.816 |
關鍵詞 | 乾體重; 細胞外體積; 血液透析; 生物阻抗分析; Dry weight; Extracellular volume; Hemodialysis; Bioimpedance analysis; |
語文 | 英文(English) |
中文摘要 | 大多數病人透析後的乾體重(dry weight)是由臨床經驗去評估而易有誤差。多頻率生物阻抗分析(multi-frequency bioimpedance analysis (BIA))提供精確的身體組成資料。以BIA測得的細胞外體積(extracellular volume (ECV))變化可用來決定血液透析病人的乾體重。本實驗依血壓和透析狀態分組,去比較血液透析病人的ECV和臨床特質,且藉由調整病人的乾體重去評估ECV,血壓,和透析狀態的變化。有121位長期接受透析至少六個月的穩定病人和74位正常人參與。在血液透析病人組,分析其ECV與血壓和透析併發症的關連性。根據他們的ECV調整乾體重,並且於四個月後重複一次BIA檢查。ECV依體重的百分率定為 ECV%,發現高血壓病人的ECV%顯著高於正常血壓的病人(24.29±3.56% vs. 21.50±2.38%,p<0.001)。ECV %對於血壓(p<0.001)和透析併發症(p<0.001)的影響是獨立的。有過多ECV%的病人全數表現高血壓,但並非每位高血壓病人都有過多的ECV%。沒有任何正常血壓病人有過多的ECV%。無症狀病人的ECV%明顯高於有症狀的病人(24.18±3.39% vs. 21.78±2.86%,p<0.001)。一些表現透析併發症狀的高血壓病人仍有過多的ECV%。我們減輕8位過多ECV%高血壓病人的乾體重,結果他們的ECV % ( 29.80±2.03% vs. 27.10±2.99%,p<0.001)和血壓(159±7/97±4 vs. 137±1/86±8mmHg, p=0.006 for systolic and p=0.004 for diastolic)都隨著下降。20位正常血壓病人的透析併發症狀隨著調高乾體重而獲得改善。結論是必須評估高血壓病人的ECV以便得到理想乾體重並且矯正高血壓。如果正常血壓病人有透析併發症,可以逐步調高他們的乾體重一直到症狀改善或是產生高血壓為止。 |
英文摘要 | In most instances, the patient’s postdialysis dry weight is empirically estimated by trial and error. Multi-frequency bio impedance analysis (BIA) provides accurate data on body composition. Extracellular volume (ECV) change measured by BIA is a useful tool to determine the dry weight of hemodialysis patients. The purpose of our study was to compare the ECV and clinical characteristics of hemodialysis patients, matching the subjects for blood pressure and dialysis status, and to adjust dry weight in these patients to evaluate changes in ECV, blood pressure, and dialysis status. 74 normal subjects and 121 stable chronic hemodialysis patients were included. The correlation of ECV to blood pressure and dialysis complications in the hemodialysis patients group was analyzed. Dry weight was adjusted according to the patients’ ECV, and a BIA exam was repeated 4 months later. The ECV as a percentage of weight (ECV%) of hypertensive patients was significantly higher than that of normotensive patients (24.29±3.56% vs. 21.50±2.38%, p<0.00l). The ECV% had an independent effect on blood pressure (p<0.001) and dialysis complications (p<0.00l). All patients with excessive ECV% developed hypertension, but not every hypertensive patient had excessive ECV%. No excessive ECV% was found for any normotensive patient. The ECV% of asymptomatic patients was significantly higher than that of symptomatic patients (24.18±3.39% vs. 21.78±2.86%, p<0.001). Furthermore, some hypertensive patients with symptoms of dialysis complications still had excessive ECV%. The dry weight decreased in 8 hypertensive patients with excessive ECV%. ECV% (29.80±2.03% vs. 27.10±2.99%, p |
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