Assessment of dry weight by monitoring changes in blood volume during hemodialysis using Crit-Line
Assessment of dry weight by monitoring changes in blood volume during hemodialysis using Crit-Line
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DOI：
10.1111/j.1523-1755.2005.00467.x
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发表时间：
2005-08-01
影响因子：
19.6
通讯作者：
Goykhman, I
中科院分区：
文献类型：
--
作者：
Rodriguez, HJ;Domenici, R;Goykhman, I
使用 Crit-Line.Background 监测血液透析期间血容量的变化来评估干重。慢性血液透析患者干重的常规评估主要依赖于患者体液状态的临床评估。我们评估了透析后血管再充盈的测量是否有助于评估干重。方法。在常规治疗过程中，使用恒定的透析液温度和透析液钠浓度对 28 名慢性、稳定的血液透析患者进行了研究，并在整个研究过程中使用 Crit-Line III 监测仪监测血容量的相对变化。该研究分为三个阶段。第一阶段研究评估了血液透析完成后血管室再充盈的时间依赖性。第 2 期研究评估了患者亚组中透析中血容量变化与停止超滤后血液透析最后 10 分钟期间透析后血管室再充盈之间的关系。第三阶段研究评估了应用血容量减少、透析后血管室再充盈方案后干重变化的程度，以及与透析中低血容量和/或透析后疲劳的临床证据的相关性。第三阶段包括三到五次治疗。结果。第一阶段研究表明，尽管透析后血管室再充盈程度存在患者间差异，但当明显再充盈时，它总是持续至少 30 分钟。然而，大部分补充发生在透析后 10 分钟内。 2 期研究确定了 3 组患者：表现出透析中血容量减少但透析后血管室再充盈的患者（第 1 组）、表现出透析中血容量减少和透析后血管室再充盈的患者（第 2 组）以及在血液透析治疗期间血容量没有显着变化的患者（第 3 组）。在第 3 期研究中，使用超滤方案减少血容量并监测透析后血管室再充盈，结合低血容量和透析后疲劳的临床评估，表明患者的临床干体重评估经常过低或过高。在所有 28 名研究的患者中，使用该方案后，干重要么增加，要么减少。结论。确定透析中血容量减少的程度和透析后血管室再充盈的程度，结合透析中低血容量和透析后疲劳的临床评估，可以帮助评估患者干重并优化容量状态，同时减少透析相关的发病率。因液体超负荷而入院的人数可能会减少。
Assessment of dry weight by monitoring changes in blood volume during hemodialysis using Crit-Line.Background. Routine assessment of dry weight in chronic hemodialysis patients relies primarily on clinical evaluation of patient fluid status. We evaluated whether measurement of postdialytic vascular refill could assist in the assessment of dry weight.Methods. Twenty-eight chronic, stable hemodialysis patients were studied during routine treatment sessions using constant dialysate temperature and dialysate sodium concentration, and relative changes in blood volume were monitored using Crit-Line III monitors throughout this study. The study was divided into three phases. Phase 1 studies evaluated the time-dependence of vascular compartment refill after completion of hemodialysis. Phase 2 studies evaluated the relationships in patient subgroups between intradialytic changes in blood volume and the presence of postdialytic vascular compartment refill during that last 10 minutes of hemodialysis after stopping ultrafiltration. Phase 3 studies evaluated the extent of dry weight changes following the application of a protocol for blood volume reduction, postdialytic vascular compartment refill, and correlation with clinical evidence of intradialytic hypovolemia and/or postdialytic fatigue. Phase 3 included anywhere from three to five treatments.Results. Phase 1 studies demonstrated that despite interpatient variability in the magnitude of postdialytic vascular compartment refill, when significant refill was evident, it always continued for at least 30 minutes. However, the majority of refill took place within 10 minutes postdialysis. Phase 2 studies identified 3 groups of patients: those who exhibited intradialytic reductions in blood volume but not postdialytic vascular compartment refill (group 1), those who exhibited intradialytic reductions in blood volume and postdialytic vascular compartment refill (group 2), and those whose blood volume did not change substantially during hemodialysis treatment (group 3). In phase 3 studies, use of an ultrafiltration protocol for blood volume reduction and monitoring of postdialytic vascular compartment refill combined with clinical assessment of hypovolemia and postdialytic fatigue demonstrated that patients often had a clinical dry weight assessment which was too low or too high. In all 28 patients studied, dry weight was either increased or decreased following use of this protocol.Conclusion. Determination of the extent of both intradialytic decreases in blood volume and postdialytic vascular compartment refill, combined with clinical assessment of intradialytic hypovolemia and postdialytic fatigue, can help assess patient dry weight and optimize volume status while reducing dialysis associated morbidity. The number of hospital admissions due to fluid overload may be reduced.