维持性血液透析患者容量负荷评估与管理的最佳证据总结

doi:10.3761/j.issn.0254-1769.2021.10.008

摘要/Abstract

摘要：

目的检索维持性血液透析患者容量负荷评估与管理的证据,并对证据进行总结,为医护人员对该类患者进行容量负荷评估与管理提供循证依据。方法检索WHO指南库、英国国家卫生与临床优化研究所网站、国际指南协作网、美国国立临床诊疗指南数据库、苏格兰大学校际指南协作网、Cochrane Library、BMJ Best Practice、UpToDate、医脉通、PubMed、Web of Science、Embase、CINAHL、中国知网、万方医学网、维普、中文生物医学期刊数据库等网站、指南库、数据库中关于维持性血液透析患者容量负荷评估与管理的证据,包括指南、证据总结、最佳实践、系统评价、Meta分析及原始研究。检索时限为2015年1月—2020年12月。筛选文献并进行质量评价,提取及归纳总结证据。结果最终纳入文献11篇,其中指南8篇,系统评价3篇。总结出容量负荷评估方法、干体重评估及优化、血压控制及药物使用、钠摄入及排出、饮食评估和水分控制、透析频率及时间、生物阻抗设备的使用7个方面,共19条最佳证据。结论在维持性血液透析患者容量负荷评估中,可采用多学科共同决策的评估方法。在实际应用中,医护人员需结合具体的临床情境及患者意愿,选择最佳证据。

关键词: 维持性血液透析, 容量负荷, 容量评估, 容量控制, 循证护理

Abstract:

Objective To retrieve the relevant evidence for the assessment and management of volume load in maintenance hemodialysis （MHD） patients,and to summarize the best evidence,so as to provide evidence-based bases for medical staff to evaluate the volume load of MHD patients. Methods The guideline database and comprehensive database were searched,including WHO Guidelines,NICE,GIN,AHRQ,SIGN,Cochrane Library,BMJ Best Practice,UpToDate,Yimaitong,PubMed,Web of Science,Embase,CINAHL,CNKI,Wanfang,Med Online,CMJD. All the evidence were searched on assessment of volume load in MHD patients,including guidelines,evidence summaries,best practice,systematic evaluations,meta analysis and original research. The retrieval time was from January 2015 to December 2020. The literature was screened and evaluated,in order to summarize the best evidence. Results 11 articles were finally included,including 8 guidelines and 3 systematic reviews（including meta-analysis）. 19 pieces of best evidence were summarized in 7 aspects including volume load assessment methods,dry weight assessment and optimization,blood pressure control and drug use,sodium intake and elimination,diet assessment and fluid restriction,dialysis frequency and time,and the use of bio-impedance equipment. Conclusion In the assessment of volume load in MHD patients,a multidisciplinary assessment method of shared decision making is practical. In clinical practice,medical staff should select the best evidence based on specific clinical situations and patient wishes. In order to improve the accuracy of the assessment of volume load in MHD patients,a scientific,effective,and easy-to-use comprehensive assessment method and capacity management measure is meant to be further studied.

Key words: Maintenance Hemodialysis, Volume Load, Volume Assessment, Capacity Management, Evidence-Based Nursing

郭佳钰, 侯惠如, 张瑞芹, 吴贞, 王志英. 维持性血液透析患者容量负荷评估与管理的最佳证据总结[J]. 中华护理杂志, 2021, 56(10): 1490-1496.

GUO Jiayu, HOU Huiru, ZHANG Ruiqin, WU Zhen, WANG Zhiying. Summary of the best evidence for the assessment and management of volume load in maintenance hemodialysis patients[J]. Chinese Journal of Nursing, 2021, 56(10): 1490-1496.

图/表 3

表1 纳入文献的一般特征（n=11）

Table 1 Characteristics of included studies（n=11）

表2 纳入指南的质量评价结果（n=8）

Table 2 The quality evaluation results of the guidelines（n=8）

表3 最佳证据总结

Table 3 Summary of the best evidence

参考文献 29

[1]	Kugler C, Maeding I, Russell CL. Non-adherence in patients on chronic hemodialysis:an international comparison study[J]. J Nephrol, 2011, 24(3):366-375. DOI URL
[2]	邱翛然, 何彩云. 维持性血液透析患者液体摄入依从性及其影响因素[J]. 护理学报, 2015, 22(6):6-10.
	Qiu XR, He CY. Fluid intake compliance of maintenance hemodialysis patients and its influencing factors[J]. J Nurs, 2015, 22(6):6-10.
[3]	张小桐, 李明旭. 通过人体成分分析比较老年和非老年血液透析患者的容量负荷和营养状况[J]. 临床肾脏病杂志, 2019, 19(2):96-101.
	Zhang XT, Li MX. Comparison of capacity load and nutritional status of elderly and non-elderly hemodialysis patients by human body composition analysis[J]. J Clin Nephrol, 2019, 19(2):96-101.
[4]	石彬, 王海芳, 汪小华, 等. 维持性血液透析病人容量管理行为水平及其对再住院率的影响[J]. 护理研究, 2018, 32(14):2221-2227.
	Shi B, Wang HF, Wang XH, et al. Volume management behavior of maintenance hemodialysis patients and its influence on rehospitalization rate[J]. Chin Nurs Res, 2018, 32(14):2221-2227.
[5]	潘春勤, 周学才, 刘杰. 维持性血液透析慢性肾功能衰竭患者死亡原因调查及相关因素分析[J]. 中国医药导报, 2013, 10(19):63-65.
	Pan CQ, Zhou XC, Liu J. Study on the cause of death and the related factors of chronic renal failure patients by maintenance hemodialysis[J]. China Med Her, 2013, 10(19):63-65.
[6]	Antlanger M, Josten P, Kammer M, et al. Blood volume-monitored regulation of ultrafiltration to decrease the dry weight in fluid-overloaded hemodialysis patients:a randomized controlled trial[J]. BMC Nephrol, 2017, 18(1):238. DOI PMID
[7]	张方圆, 沈傲梅, 曾宪涛, 等. 系统评价方法学质量评价工具AMSTAR 2解读[J]. 中国循证心血管医学杂志, 2018, 10(1):14-18.
	Zhang FY, Shen AM, Zeng XT. An introduction to AMSTAR 2:a critical appraisal tool for systematic reviews[J]. Chin J Evid Based Cardiovasc Med, 2018, 10(1):14-18.
[8]	谢利民, 王文岳. 《临床指南研究与评价系统Ⅱ》简介[J]. 中西医结合学报, 2012, 10(2):160-165. DOI URL
	Xie LM, Wang WY. Introduction of appraisal of guidelines for research and evaluation[J]. J Chin Integr Med, 2012, 10(2):160-165. DOI URL
[9]	俞梦英, 卢芳燕, 应华杰. 胰十二指肠切除术后患者早期肠内营养的最佳证据总结[J]. 中华护理杂志, 2021, 56(1):62-68.
	Yu MY, Lu FY, Ying HJ. Summary of the best evidence for early enteral nutrition in patients after pancreatoduodenectomy[J]. Chin J Nurs, 2021, 56(1):62-68.
[10]	Kidney Disease Outcomes Quality Initiative. KDOQI clinical practice guideline for hemodialysis adequacy:2015 update[J]. Am J Kidney Dis, 2015, 66(5):884-930. DOI URL
[11]	Watanabe Y, Kawanishi H, Suzuki K, et al. Japanese society for dialysis therapy clinical guideline for “maintenance hemodialysis:hemodialysis prescriptions”[J]. Ther Apher Dial, 2015, 19(Suppl 1):67-92. DOI URL
[12]	Japanese Society of Nephrology. Essential points from evidence-based clinical practice guidelines for chronic kidney disease 2018[J]. Clin Exp Nephrol, 2019, 23(1):1-15. DOI URL
[13]	National Institute for Health and Care Excellence. Renal replacement therapy and conservative management[M]. London:National Institute for Health and Care Excellence, 2018.
[14]	National Institute for Health and Care Excellence. Multiple frequency bioimpedance devices to guide fluid management in people with chronic kidney disease having dialysis[M]. London:National Institute for Health and Care Excellence, 2017.
[15]	Covic A, Ciumanghel AI, Siriopol D, et al. Value of bioimpedance analysis estimated “dry weight” in maintenance dialysis patients:a systematic review and meta-analysis[J]. Int Urol Nephrol, 2017, 49(12):2231-2245. DOI URL
[16]	Ashby D, Borman N, Burton J, et al. Clinical practice guideline haemodialysis[M]. London:The Renal Association, 2019.
[17]	王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015, 30(11):964-967.
	Wang CQ, Hu Y. Joanna Briggs Institute levels of evidence and grades of recommandation[J]. J Nurs Train, 2015, 30(11):964-967.
[18]	Agency for Healthcare Research and Quality. End-stage renal disease in the medicare population:frequency and duration of hemodialysis and quality of life assessment[J]. Technol Assess Program, 2020, 7:1-108.
[19]	Cheng YL, Tang HL, Tong MKL. Clinical practice guidelines for the provision of renal service in Hongkong:haemodialysis[J]. Nephrology(Carlton), 2019, 24(Suppl 1):41-59.
[20]	Yang Y, Wang R, Li MX, et al. Effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on left ventricular mass index and ejection fraction in hemodialysis patients:a Meta-analysis with trial sequential analysis of randomized controlled trials[J]. Int J Cardiol, 2016, 219:350-357. DOI PMID
[21]	刘文虎, 孙雪峰, 林洪丽, 等. 中国血液透析充分性临床实践指南[J]. 中华医学杂志, 2015, 95(34):2748-2753.
	Liu WH, Sun XF, Lin HL, et al. Clinical practice guidelines for hemodialysis adequacy in China[J]. Natl Med J China, 2015, 95(34):2748-2753.
[22]	高雅靖, 单岩, 周越, 等. 老年晚期慢性肾脏病患者共享决策的研究进展[J]. 中国护理管理, 2020, 20(9):1409-1412.
	Gao YJ, Shan Y, Zhou Y, et al. Research progress of shared decision making in elderly patients with advanced chronic kidney disease[J]. Chin Nurs Manag, 2020, 20(9):1409-1412.
[23]	John T, Daugirdas, Peter GB. 透析手册[M]. 北京: 人民卫生出版社, 2017.
	John T, Daugirdas, Peter GB. Handbook of dialysis[M]. Beijing: People’s Medical Publishing House, 2017.
[24]	Movilli E, Gaggia P, Zubani R, et al. Association between high ultrafiltration rates and mortality in uraemic patients on regular haemodialysis. A 5-year prospective observational multicentre study[J]. Nephrol Dial Transplant, 2007, 22(12):3547-3552. DOI URL
[25]	梅长林, 高翔, 叶朝阳. 实用透析手册[M]. 3版. 北京: 人民卫生出版社, 2017.
	Mei CL, Gao X, Ye CY. Practical dialysis handbook[M]. 3rd ed. Beijing: People’s Medical Publishing House, 2017.
[26]	Agarwal R, Satyan S, Alborzi P, et al. Home blood pressure measurements for managing hypertension in hemodialysis patients[J]. Am J Nephrol, 2009, 30(2):126-134. DOI PMID
[27]	Bansal N, McCulloch CE, Rahman M, et al. Blood pressure and risk of all-cause mortality in advanced chronic kidney disease and hemodialysis:the chronic renal insufficiency cohort study[J]. Hypertension, 2015, 65(1):93-100. DOI PMID
[28]	Alborzi P, Patel N, Agarwal R. Home blood pressures are of greater prognostic value than hemodialysis unit recordings[J]. Clin J Am Soc Nephrol, 2007, 2(6):1228-1234. DOI URL
[29]	李倩倩, 魏丽丽, 庞旭峰, 等. 人体成分测量辅助评估血液透析患者液体负荷的效果研究[J]. 中华护理杂志, 2019, 54(6):812-816.
	Li QQ, Wei LL, Pang XF, et al. Clinical study of bioelectrical impedance assisted assessment of volume in hemodialysis patients[J]. Chin J Nurs, 2019, 54(6):812-816.