當然有,來看看研究能告訴我們哪些事情。
首先是2006年的研究,七個國家的跨國大型研究,共有22000人參與,結論:透析時間越長,以及脫水速度越慢,死亡率越低。
透析時間長,我們會想到清除率(Kt/V)當然更好,當然死亡率越低,但這篇研究特別告訴我們是:透析時間長與清除率高,兩者皆為降低死亡率的獨立因子。這個研究中,歐洲國家比美國的透析時間平均長21分鐘,甚至,日本比美國的透析時間平均長33分鐘!日本的死亡率可以比美國低快要20%!(RR=0.81; P=0.0005)
單單把透析時間拉長,就能夠降低死亡率,那麼脫水速度呢?這篇是用脫水速度 10 cc/kg/hr 當分界,把患者分成兩組,發現大於這個速度者,死亡率會增加,透析中間發生低血壓的情況,也會增加。意思就是:洗的比較容易不舒服啦!
第二篇是2011年的研究,1846人的研究,直接先看圖:
可以很清楚的看出,只要脫水速度大於 10 cc/kg/hr,死亡率就開始上升,文中把大於 13 cc/kg/hr 的患者再分一組,這樣的脫水速度,不管是總死亡率、還是心血管疾病的死亡率,都顯著增加。
用這樣的數據,就可以算出患者一次最多能脫水的量,透析時間都用四個小時計算,以下表格幫助速算:
患者體重 (公斤) | 40 | 50 | 60 | 70 |
10 cc/kg/hr 是多少水? | 1.6公斤 | 2.0公斤 | 2.4公斤 | 2.8公斤 |
13 cc/kg/hr 是多少水? | 2.0公斤 | 2.6公斤 | 3.1公斤 | 3.6公斤 |
如果用體重的百分比來算,四小時的透析時間,所能透析的體重最好在 4% 以下 (10 cc/kg/hr),最多不可超過 5.2% (13 cc/kg/hr) 。
想要脫更多水?可以,請延長時間!延長透析時間既可以增加清除率,降低死亡率,又能使脫水速度變慢,一舉三得!
結論:洗腎患者要控制水分攝取,兩次透析之間的體重增加,不能超過上述的數據,不然洗的不舒服、又比別人容易心血管疾病掛掉。
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