Bioimpedance Spectroscopy and Fluid Management in Dialysis Patients: From Laboratory to Clinic

生物阻抗頻譜分析與透析病人的水分控制：由實驗室走入臨床

吳再坤(Tsai-Kun Wu) ； 陳宏賓(Hong-Bin Chen) ； 陳昶旭(Chang-Hsu Chen) ； 曾天佑(Tien-Yu Tseng) ； 林柏松(Paik-Seong Lim)

《童綜合醫學雜誌》 15卷S期 (2021/09) Pp. 13-23

https://doi.org/10.3966/20713592202109150S003

摘要

Many patients on dialysis are older adults with numerous comorbid conditions and poor nutritional health. Improving fluid and nutritional status are major treatment goals for patients on dialysis, who should regularly receive both fluid as well as nutritional assessment by dialysis staff. Anthropometric and body composition assessments provide important nutritional status information. However, most assessment methods have a limited application in patients on dialysis because dialysis alters their hydration status. On the other hand, body composition estimates from single- and multifrequency bioelectrical impedance in healthy individuals are well established. However, most bioelectrical impedance methods employ some form of predictive modeling to obtain estimated outcomes have some inherent problems in patients on dialysis. A body composition monitor based on bioimpedance spectroscopy (BIS) with modified fluid and physiological models has been developed in recent years to detect excessive fluid in patients on dialysis. Due to its non-invasive and easy-to-perform characteristics, it has been increasingly applied as a bedside tool to evaluate patients' fluid status in many dialysis facilities worldwide. Furthermore, BIS is also useful in assessing nutritional status and adequacy of patients on dialysis in the clinical setting. We present a rigorous review of the recent publications that address these issues.

關鍵字

body bioimpedance ； nutrition ； fluid management ； dialysis

並列摘要

許多透析病人為年長、罹患多重共病且營養狀況不良。透析醫護人員經由水分及營養規則性評估是改善病人水分及營養狀態的重要方法。經由人體及身體組成的量測方式，可以提供透析病人的重要營養訊息。然而，由於此些檢驗方式的預先假設，以及透析改變了體內水分的狀態，限制了此些測量於透析病人的應用性。另一方面，身體組成測量方式，是經由單一或多個電生物阻抗在健康民眾推估實驗而設立。此外，大多數電生物阻抗法推估出的預後模組，於透析病人存在其根本問題。近幾年，根據生物阻抗頻譜分析水分及生理改變的型態，設計出監測透析病人體內是否水分過多組成的儀器。由於具有非侵襲性、使用方便等特性，全世界越來越多的透析機構及醫療人員運用此儀器於床邊評估透析病人水分。此外，生物阻抗頻譜分析儀對於評估營養狀況及透析病人的透析是否充足也有臨床重要性。我們回顧及整理近幾年此議題的文獻並提供重要相關性。

並列關鍵字

生物阻抗 ； 營養 ； 水分 ； 透析