| Objective:?To investigate the clinical practice and difference of dry weight assessment methods in blood purification centers by multi-center cross-sectional survey.?To evaluate the intervention effect of dry weight on clinical benefit and survival benefit of patients with HD by bioelectric impedance method(BIA),and to provide objective evaluation tool for patients with fluid management? A randomized controlled trial was used to compare the difference between the traditional clinical evaluation group and the bioelectric impedance assistant evaluation group in improving the liquid management status of hemodialysis patients,the purpose of this study was to provide an objective method for evaluating dry weight and to improve the quality of life of the patients through the accurate measurement of dry weight.To reduce the incidence of complications and to provide objective tools for hemodialysis nurses to improve the quality of life of hemodialysis patients.Methods:?A multi-center cross-sectional survey was carried out by using the convenient sampling method.The head nurses and doctors of the hemodialysis rooms in 172 hospitals in Jiangsu province were investigated with self-designed questionnaire.?The present situation of dry weight assessment was investigated based on the theory of nursing evidence.Computerized retrieval of CENTRAL,Cochrane clinical controlled trial center registry,Pubmed?EMbase?EBsco?Wanfang Data?Web of science?China Biomedical document Service system?China National Knowledge Infrastructure(CNKI)bioelectrical impedance method for assessing fluid status of hemodialysis patients using a systematic evaluation method,The time limit for retrieval is from the establishment of the database to July 15,2016.According to the inclusion and exclusion criteria,two researchers sift documents,extract information,and evaluate the quality,Then Meta analysis or descriptive analysis with RevMan5.3 software was used to evaluate the intervention effect of BIA management fluid status on the clinical and survival benefits of patients.?The multicenter randomized controlled study was used to follow up hemodialysis patients for half a year.The differences of blood pressure,home blood pressure reaching standard rate,volume control reaching standard rate,left ventricular mass index and quality of life score were compared between the traditional clinical evaluation group and the bioelectrical impedance assistant evaluation group.Results:? 172 blood purification centers had different methods of dry weight assessment.Among them,the subjective method,the clinical evaluation method(CA)accounted for 100%*the objective assessment method,the chest radiographs accounted for 43.1%and the B type natriuretic peptide(BNP)accounted for 7.6%,the biological impedance method(BIA)accounted for 3.5%,the inferior vena cava diameter(IVCD)accounted for 1.7%,the inferior vena cava diameter(IVCD)accounted for 1.7%,and the relative blood volume monitoring method(RPV)accounted for 7.6%.Of the total number of hospitals adopting subjective and objective combined method of integrated assessment is 80 cases,accounted for 46.5%,The other 92 cases were evaluated by a single clinical evaluation method.The clinical practice of comprehensive evaluation of dry weight was different.And there are significant differences between the second and third level hospitals.?Meta analysis results showed that the intervention of fluid management by BIA could improve blood pressure of the patients,improve the heart function of patients,reduce the hospitalization rate,but the existing BIA intervention patients related research is relatively few in China,and in the selection of indicators,dry weight evaluation frequency and other aspects need to be further standardized.?The results of a randomized controlled study showed that biological resistance aided evaluation of patients with dry weight helps to reduce systolic blood pressure and increase the patients' family blood pressure control rate(P<0.05);while in the consulting room observation indexes of diastolic pressure and left ventricular mass index,bioelectrical impedance assisted assessment group although showed certain advantages,but the difference between the two groups was not statistically significant(P>0.05).In terms of quality of life,bioimpedance intervention in two dimensions to improve symptoms and discomfort and patient satisfaction scores of the patients.In the intervention group,87.2%satisfied with the content and frequency of intervention.Conclusion:At present,the comprehensive evaluation method of dry weight of hemodialysis patients is not ideal,and the clinical benefits of bioelectrical impedance intervention need to be further verified.In this study,bioelectrical impedance assisted assessment of dry weight can improve systolic blood pressure and family blood reaching standard rate;In long run,it may improve diastolic blood pressure and left ventricular function,and further improve patients' quality of life. |
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