CN108986920A - Dialysis adequacy in chronic protein decomposition rate appraisal procedure and system - Google Patents
Dialysis adequacy in chronic protein decomposition rate appraisal procedure and system Download PDFInfo
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Abstract
The present invention relates to dialysis adequacy in chronic protein decomposition rate appraisal procedure and system, this method includes that urea distribution volume is calculated according to the last biochemical investigation data of acquisition；Urea, which is calculated, according to the urea distribution volume and specified parameter generates speed；Speed is generated according to the urea and weight calculates Normalized protein catabolic rate；The Normalized protein catabolic rate of display output adequacy assessment.Compared with prior art, the present invention is calculated the Normalized protein catabolic rate of the dialysis adequacy in chronic of patient, to reach optimum reelability quality after guaranteeing patients with hemodialysis, is finally realized ideal dialysis adequacy in chronic by analysis data cooperation dialysis record.
Description
Technical field
The present invention relates to medical data field more particularly to dialysis adequacy in chronic protein decomposition rate appraisal procedures and system.
Background technique
Kidney trouble is to seriously endanger the great chronic disease of human health, is usually treated with renal replacement therapy.Kidney
Alternative medicine continuous, slow water and solute removed in blood usually in such a way that extracorporeally circulating blood is dialysed, to substitute kidney
Dirty function is preferably minimized the influence of solute concentration and volume change to body in blood.In renal replacement therapies to dialyse into
The assessment of row adequacy is to guarantee the important method of therapeutic quality.In the renal replacement therapies process for being directed to such as uremic patient
In, in order to improve the life quality of maintenance hemodialysis (HD) patient, it is necessary to accomplish that dialysis is abundant.Dialysis adequacy in chronic is to influence
An important factor for terminal phase kidney patients' prognosis, large-scale international, multicenter haemodialysis research data are shown: terminal phase kidney
Dirty patient, which receives sufficient hemodialysis, can reduce the morbidity and mortality of complication.Adequacy is carried out to haemodialysis
Assessment is to improve dialysis, guarantees the important method of dialysis quality.
PCR is the important indicator that protein decomposition rate (g/d) is dialysis adequacy in chronic, usually with weight come marking, referred to as
Normalized protein catabolic rate, i.e. nPCR, unit are g/ (kg.d).When patient nPCR is less than 0.8g/ (kg.d), complication of dialysing
Incidence and the death rate increase.In general, patient nPCR should maintain 1.0g/ (kg.d) or more.When patient nPCR is too low
Its nutrient protein situation need to be assessed.
The domestic practical methods for carrying out nPCR assessment to haemodialysis are mainly based upon the blood of China's publication in 2010 at present
To protein decomposition rate (PCR) calculation formula in liquid purification standard operating instruction, describe as PCR=(the preceding rear plasma wrea of blood urea nitrogen-
Nitrogen) × (0.045/2 blood specimen interval number of days)；Preceding blood urea nitrogen: the blood urea nitrogen surveyed before dialysis next time.Blood urea nitrogen afterwards:
The blood urea nitrogen surveyed after this dialysis.2 blood specimen interval number of days: dialysing next time and the interval number of days of this dialysis.This meter
Calculation method is fairly simple, but also relatively coarse, does not account for the individual instances of different patients, can make calculated result and practical egg
White decomposition situation gap is larger.
Summary of the invention
In view of above-mentioned analysis, the present invention is intended to provide dialysis adequacy in chronic protein decomposition rate appraisal procedure and system, solve
The prior art does not account for the individual instances of different patients in dialysis procedure, can make calculated result and practical protein breakdown feelings
The larger problem of condition gap.
The purpose of the present invention is mainly achieved through the following technical solutions:
On the one hand, the embodiment of the invention provides dialysis adequacy in chronic protein decomposition rate appraisal procedure and system, this method packets
It includes and urea distribution volume is calculated according to the last biochemical investigation data of acquisition；According to the urea distribution volume and
Specified parameter calculates urea and generates speed；Speed is generated according to the urea and weight calculates normalization protein and decomposes
Rate；The Normalized protein catabolic rate of display output adequacy assessment.
One embodiment based on the above method, by the Normalized protein catabolic rate of each dialysis adequacy in chronic and corresponding
Diagnosis and treatment data store in the database.
Optionally, urea distribution volume is calculated according to the last biochemical investigation data of acquisition includes: according to fixed
Phase analysis data and chemical examination the same day dialysis data, obtain dialysis start when and dialysis at the end of blood urea concentration, dialysis
Time, water removal, blood flow, urea removing coefficient；After initial urea distribution volume uses an assumed value, calculating dialysis to start
Urea concentration per unit time obtains the urea concentration under the conditions of the urea distribution volume at the end of dialysis；By not
Disconnected adjustment urea distribution volume assumed value, so that the urea concentration chemically examined at the end of calculated urea concentration and dialysis is consistent,
Obtain actual urea distribution volume；Wherein, the last biochemical investigation data of the acquisition include defeated by input interface
Enter biochemical investigation data or the automatic collection biochemical investigation data from the medical system of biochemical investigation data.
Optionally, calculating urea to generate speed according to the urea distribution volume and specified parameter includes: to dialyse
Actual urea distribution volume when beginning is it is known that most according to the urea concentration of blood when dialysis beginning and the acquisition
The urea concentration and urea distribution volume of blood at the end of nearly primary dialysis, and urea is calculated according to the following formula and generates speed
Degree,
Wherein, g indicates that urea generates speed, and Vs indicates urea distribution volume when this dialysis starts, and Cs indicates this thoroughly
The urea concentration of blood when analysis starts, Vpe indicate urea distribution volume at the end of the last dialysis, and Cpe indicates the last
The urea concentration of blood, T at the end of dialysisIIndicate this and the last time interval.
Optionally, calculating Normalized protein catabolic rate according to urea generation speed and weight includes: according to institute
It states urea generation speed and protein decomposition rate is calculated according to following formula,
PCR=9.35g+11.04
Wherein, PCR is protein decomposition rate；
According to the protein decomposition rate and weight according to following formula normalized protein decomposition rate,
NPCR=PCR/BW
Wherein, nPCR is Normalized protein catabolic rate, and BW is weight.
The technical program has the beneficial effect that: the invention discloses dialysis adequacy in chronic protein decomposition rate appraisal procedures, should
Method includes that urea distribution volume is calculated according to the last biochemical investigation data of acquisition；It is distributed and is held according to the urea
Long-pending and specified parameter calculates urea and generates speed；Speed is generated according to the urea and weight calculates normalization protein
Resolution ratio；The Normalized protein catabolic rate of display output adequacy assessment.Compared with prior art, the method for the present invention provides
A kind of more accurate calculation method of the protein decomposition rate of hemodialysis patients is made by the parsing to urea kinetic
Urea distribution volume is calculated with the blood urea nitrogen of the urea clearance of dialyzer, dialysis time, Before and after dialysis, to calculate
The method of protein decomposition rate considers the individual instances of different patients, keeps calculated result consistent with practical protein breakdown situation.
On the other hand, the embodiment of the invention provides dialysis adequacy in chronic protein decomposition rate assessment system, which includes: defeated
Enter unit, computing unit and output unit；Input unit, for obtaining the last biochemical investigation data；Computing unit is used for
Be calculated urea distribution volume according to the last biochemical investigation data of acquisition, and according to the urea distribution volume and
Specified parameter calculates urea and generates speed, further generates speed according to the urea and weight calculates normalization protein
Resolution ratio；Output unit, for showing the Normalized protein catabolic rate of output adequacy assessment.
Another embodiment based on above system, the system further include storage unit, abundant for storing dialysis every time
The Normalized protein catabolic rate of property and corresponding diagnosis and treatment data.
Optionally, the input unit is specifically used for by input interface input biochemical investigation data or from biochemical investigation
Automatic collection biochemical investigation data in the medical system of data.
Optionally, the computing unit is specifically used for that urea is calculated according to the last biochemical investigation data of acquisition
Distribution volume includes: to be obtained when dialysis starts and at the end of dialysis according to the dialysis data of regular analysis data and the chemical examination same day
Urea concentration, dialysis time, water removal, blood flow, the urea removing coefficient of blood；Initial urea distribution volume uses a vacation
Definite value calculates the urea concentration after dialysis starts per unit time at the end of dialysis, obtains the urea distribution volume condition
Under urea concentration；By constantly adjusting urea distribution volume assumed value, so that at the end of calculated urea concentration and dialysis
The urea concentration of chemical examination is consistent, obtains actual urea distribution volume.
Optionally, the computing unit is also used to according to the urea distribution volume and specified parameter according to following public affairs
Formula calculates urea and generates speed:
Wherein, g indicates that urea generates speed, and Vs indicates urea distribution volume when this dialysis starts, and Cs indicates this thoroughly
The urea concentration of blood when analysis starts, Vpe indicate urea distribution volume at the end of the last dialysis, and Cpe indicates the last
The urea concentration of blood, T at the end of dialysisIIndicate this and the last time interval；Further produced according to the urea
It gives birth to speed and weight and calculates Normalized protein catabolic rate according to following formula: PCR=9.35g+11.04, nPCR=PCR/
Wherein, PCR is protein decomposition rate to BW, and nPCR is Normalized protein catabolic rate, and BW is weight.
Other features and advantages of the present invention will illustrate in the following description, also, partial become from specification
It obtains it is clear that understand through the implementation of the invention.The objectives and other advantages of the invention can be by written explanation
Specifically noted structure is achieved and obtained in book, claims and attached drawing.
Detailed description of the invention
Attached drawing is only used for showing the purpose of specific embodiment, and is not to be construed as limiting the invention, in entire attached drawing
In, identical reference symbol indicates identical component.
Fig. 1 is dialysis adequacy in chronic protein decomposition rate appraisal procedure flow chart provided in an embodiment of the present invention；
Fig. 2 is the algorithm flow chart of dialysis adequacy in chronic protein decomposition rate appraisal procedure provided in an embodiment of the present invention；
Fig. 3 is dialysis adequacy in chronic protein decomposition rate assessment system structural schematic diagram provided in an embodiment of the present invention.
Specific embodiment
Specifically describing the preferred embodiment of the present invention with reference to the accompanying drawing, wherein attached drawing constitutes the application a part, and
Together with embodiments of the present invention for illustrating the principle of the present invention, it is not intended to limit the scope of the present invention.
The domestic practical methods for carrying out nPCR assessment to haemodialysis are mainly based upon the blood of China's publication in 2010 at present
To protein decomposition rate (PCR) calculation formula in liquid purification standard operating instruction, describe as PCR=(the preceding rear plasma wrea of blood urea nitrogen-
Nitrogen) × (0.045/2 blood specimen interval number of days)；Preceding blood urea nitrogen: the blood urea nitrogen surveyed before dialysis next time.Blood urea nitrogen afterwards:
The blood urea nitrogen surveyed after this dialysis.2 blood specimen interval number of days: dialysing next time and the interval number of days of this dialysis.This meter
Calculation method is fairly simple, but also relatively coarse, does not account for the individual instances of different patients, can make calculated result and practical egg
White decomposition situation gap is larger.
A specific embodiment according to the present invention, discloses dialysis adequacy in chronic protein decomposition rate appraisal procedure, such as Fig. 1 institute
Show, including the following steps:
Urea distribution volume is calculated according to the last biochemical investigation data of acquisition in S101；
S102 calculates urea according to the urea distribution volume and specified parameter and generates speed；
S103 generates speed according to the urea and weight calculates Normalized protein catabolic rate；
S104, the Normalized protein catabolic rate of display output adequacy assessment.
As shown in Figure 1 it is found that the dialysis adequacy in chronic protein decomposition rate appraisal procedure of the embodiment of the present invention, most according to acquisition
Urea distribution volume is calculated in nearly biochemical investigation data；It is calculated according to the urea distribution volume and specified parameter
Urea generates speed；Speed is generated according to the urea and weight calculates Normalized protein catabolic rate；Display output is primary
The Normalized protein catabolic rate of adequacy assessment.Compared with prior art, the individual instances for considering different patients, using albumen point
The more accurate calculation method of solution rate keeps calculated result consistent with practical protein breakdown situation.
A specific embodiment of the invention further includes by the Normalized protein catabolic rate of each dialysis adequacy in chronic and right
The diagnosis and treatment data storage answered is in the database.That is the history diagnosis and treatment number of a large amount of patients is stored in the database of medical system
According to, provide empirical historical data for algorithm software and model algorithm carry out assessment operation, and store patient per dialysis it is abundant
Property assessment result that is, by being collected and analyzed to long-term hemodialysis patients' dialysis treatment and regular biochemical investigation data be doctor
The appraisal procedure and algorithm of critical evaluation index needed for providing, to assist doctor to realize to the correct treatment of patient and best prognosis
Assessment.
It should be noted that needing examining using a large amount of patients stored in database if patient is to dialyse for the first time
Treat data, comprising: name, gender, age, height, saturating age, weight, dialysis time, biochemical investigation data and dialysis information data
Deng being compared decision, screen and be suitble to patient Dialysis scheme is referred to for medical staff for the first time.
Fig. 2 is the algorithm flow chart of the dialysis adequacy in chronic protein decomposition rate appraisal procedure of the embodiment of the present invention.
Urea distribution is calculated according to the last biochemical investigation data of acquisition in a specific embodiment of the invention
Volume include: according to regular analysis data and chemical examination the same day dialysis data, obtain dialysis start when and dialysis at the end of blood
Urea concentration, dialysis time, water removal, blood flow, urea removing coefficient；Initial urea distribution volume uses a hypothesis
Value calculates after dialysis starts urea concentration per unit time at the end of dialysis, under the conditions of obtaining the urea distribution volume
Urea concentration；By constantly adjusting urea distribution volume assumed value, so that changing at the end of calculated urea concentration and dialysis
The urea concentration tested is consistent, obtains actual urea distribution volume；Wherein, the last biochemical investigation data packet of the acquisition
It includes and biochemical investigation data or the automatic collection biochemical investigation number from the medical system of biochemical investigation data is inputted by input interface
According to.
It needs exist for illustrating, the biochemical investigation data value of manual or automatic acquisition includes: urea before the date of inspection, dialysis
Phosphorus after phosphorus, dialysis before sodium, dialysis after sodium, dialysis before creatinine, dialysis after creatinine, dialysis before urea nitrogen, dialysis after nitrogen, dialysis, thoroughly
Potassium etc. after potassium, dialysis before analysing, and the dialysis parameters information data of manual or automatic acquisition includes: dialysis date, dialysis duration, blood
Weight, urea clearance of dialyzer etc. after weight, dialysis before weight, dialysis after flow velocity, dialysate flow rate, last time dialysis.
The development of the local urea kinetic calculation method of Schuneditz is made below and being illustrated.
What is be clinically most widely used at present is used on the basis of single chamber urea kinetic
The second generation formula that Daugirdas1993 is released calculates single chamber Kt/V (spKt/V).Kt/V natural logrithm formula Kt/V=-Ln
(R-0.008 × t)+(4-3.5 × R) × UF/W, wherein Ln is natural logrithm；R is (BUN after dialysis)/(BUN before dialysing)；T is
It the time once dialysed, is indicated with hour；UF is ultrafiltration volume, is indicated with liter；W is weight after patients with hemodialysis, is indicated with kilogram；
BUN indicates urea nitrogen content, i.e. urea concentration.
The present invention is that a new follow-on algorithm is proposed based on single chamber urea kinetic, is called
The local urea kinetic of Schuneditz must could obtain BUN urine by blood test when avoiding each dialysis
Plain concentration is to calculate Kt/V.Urea clearance index, that is, Kt/V accounts for internal total urea volume for dialyzer clearance urea volume
Ratio.Wherein, K represents dialyzer to the clearance rate (L/h) of urea, records on dialyzer product description；T is single dialysis
Time (h)；V is the distribution volume (L) of urea in vivo, the i.e. intracorporal total moisture volume of people, from weight, height, body surface area
It is calculated.Kt product reflects single dialysis to the clearing amount of urea, and Kt/V then reflects single dialysis removing urea amount and accounts for
The ratio of patient's body urea total amount.
The local urea kinetic of Schuneditz is based on observation below as a result, there is moisture content height in human body
The few internal organs of blood (low blood flow internal organs: muscle, bone, skin, adipose tissue etc.) and moisture content lack blood high internal organs (high blood
Flow internal organs: heart, brain, digestive organs, lung etc.).The intracorporal moisture content abbreviation body fluid volume of people.
The local urea kinetic of Schuneditz can be dirty by low blood flow internal organs, the high blood flow of any time t
Urea concentration in device and arterial blood acquires the formula of the urea concentration behind interval per unit time, is spaced per unit time here
It can need to be set as 1 minute according to practical clinical.
In the local urea kinetic of Schuneditz, the blood volume Q of heart outflowAIt indicates, what heart flowed back to
Blood volume QFIt indicates, it is exactly the blood volume for flowing back into each internal organs that heart, which flows out blood volume and flows back to the difference of blood volume,.High blood flow
The blood flow Q of internal organsHIt indicates, the blood flow Q of low blood flow internal organsLIt indicates.In the overall process of dialysis, Schuneditz's
In local urea kinetic, VHIndicate the moisture content in high blood flow internal organs, VLIndicate that the moisture in low blood flow internal organs contains
Amount.VH(t) moisture content in the high blood flow internal organs of time t is indicated.VH(t+1) water in the high blood flow internal organs of time t+1 is indicated
Divide content.VL(t) moisture content in the low blood flow internal organs of time t is indicated.VL(t+1) in the low blood flow internal organs for indicating time t+1
Moisture content.The water removal in the unit time is indicated with F simultaneously, i.e., is calculated by the total water removal once dialysed,
So as to obtain each internal organs moisture content of time t+1 from the moisture content in each internal organs of time t.
The variable quantity of urea content any time point in dialysis in high blood flow internal organs, which was equal in the unit time, passes through blood
Flow into the urea amount of high blood flow internal organs and the difference of the urea amount flowed out from the internal organs by blood.Flow into the artery of high blood flow internal organs
Urea concentration C in bloodA(t) it indicates, the urea concentration C of high blood flow internal organsH(t) it indicates, blood flow QHIt indicates.At this
In a model, it is assumed that the blood flow for flowing into high blood flow internal organs in the unit time is constant, while the blood flowed out from high blood flow internal organs
Urea concentration in liquid is consistent with the urea concentration in high blood flow internal organs.Pass through the available following public affairs of above-described model
Formula:
Similarly, by the urea concentration C of low blood flow internal organsL(t) it indicates, blood flow QLIt indicates, available following formula
It sets up:
The urea amount of high blood flow internal organs can pass through the amount of moisture of the urea concentration and high blood flow internal organs of high blood flow internal organs
Product obtains.The urea amount of low blood flow internal organs can pass through the amount of moisture of the urea concentration and low blood flow internal organs of low blood flow internal organs
Product obtains.The total urea amount of both high blood flow internal organs and low blood flow internal organs is crossed according to the variable quantity and dialyzer of time t and is filtered out
Both urea amounts gone are equal, while flowing into the urea concentration in the arterial bloods of high blood flow internal organs or low blood flow internal organs according to the time
Both urea amounts that the variable quantity and dialyzer of t is filtered to remove are also equal, i.e., urea changes in high blood flow internal organs, low blood flow internal organs
It measures equal with the urea variable quantity three of urea variable quantity and dialyzer filtering in arterial blood.The urea clearance of dialyzer is used
K expression, blood flow QAIt indicates, obtains following formula:
It will be clear that urea distribution volume is calculated in the last biochemical investigation data according to acquisition, calculate
Method process include: according to regular analysis data and chemical examination the same day dialysis data, obtain dialysis start when and dialysis at the end of blood
Urea concentration, dialysis time, water removal, blood flow, the urea removing coefficient of liquid；Initial urea distribution volume uses a hypothesis
Value calculates after dialysis starts urea concentration per unit time at the end of dialysis, under the conditions of obtaining the urea distribution volume
Urea concentration；By constantly adjusting urea distribution volume assumed value, so that changing at the end of calculated urea concentration and dialysis
The urea concentration tested is consistent, obtains actual urea distribution volume.Using the local Urea bemodynamics of above-mentioned Schuneditz
Model algorithm.
A specific embodiment of the invention calculates urea according to the urea distribution volume and specified parameter and generates
Speed include: dialyse start when the actual urea distribution volume it is known that when being started according to dialysis blood urea concentration
And at the end of the last dialysis of the acquisition blood urea concentration and urea distribution volume, and count according to the following formula
Calculation obtains urea and generates speed,Wherein, g indicates that urea generates speed, and Vs indicates this dialysis
Urea distribution volume when beginning, Cs indicate that the urea concentration of blood when this dialysis starts, Vpe indicate that the last dialysis terminates
When urea distribution volume, Cpe indicates the urea concentration of blood at the end of the last dialysis, TIIndicate this and the last time
Time interval.
A specific embodiment of the invention generates speed according to the urea and weight calculates normalization protein point
Solution rate includes: to generate speed according to the urea to be calculated protein decomposition rate according to following formula, PCR=9.35g+11.04,
Wherein, PCR is protein decomposition rate；According to the protein decomposition rate and weight according to following formula normalized protein breakdown
Rate, nPCR=PCR/BW, wherein nPCR is Normalized protein catabolic rate, and BW is weight.
It should be noted that algorithm flow chart as shown in Figure 2, it is known that algorithm of the invention mainly divides four steps to complete, i.e.,
The urea distribution volume of patient is calculated by using regular analysis data, and urea generation is calculated with this urea distribution volume
Then speed generates speed by urea and weight normalized protein decomposition rate is calculated.The specific steps of algorithm flow chart
It is as follows:
S201 calculates urea distribution volume:, can be with by the dialysis data of the regular analysis data of patient and the chemical examination same day
The urea concentration in blood when dialysis starts and at the end of dialysis, dialysis time, water removal, blood flow, urea is obtained to remove
The actual value of whole parameters other than the urea such as rate distribution volume, and initial urea distribution volume first uses an assumed value, passes through
Formula calculating dialysis starts rear each minute urea concentration to be terminated until dialysing, and obtains the meter under the conditions of the urea distribution volume
Calculate urea concentration.By constantly adjusting the value of urea distribution volume hypothesis, obtain making calculated urea concentration and chemical examination urea
The value of the consistent urea distribution volume of concentration.The project table of the input parameter and output result that are calculated the following are urea distribution volume
1:
| Patient's name | - |
| Dialysis time (hr) | Input |
| Blood flow (ml/min) | Input |
| Dialysate flow (ml/min) | Input |
| Except water inventory (L) | Input |
| Weight (kg) after dialysis | Input |
| Urea clearance (mL/min) | Input |
| BUN (mg/dL) before this is dialysed | Input |
| BUN (mg/dL) after this dialysis | Input |
| Body fluid volume (ml) | Output |
| Weight (kg) after dialysis when determining body fluid volume | Output |
S202 calculates urea and generates speed: the urea of blood when urea total amount when this dialysis starts starts for this
The product of urea distribution volume when concentration starts with this, the urea total amount at the end of last time dialysis are blood at the end of the last time
The urea concentration of liquid and it is last at the end of urea distribution volume product.Urea when the increased amount of urea starts for this is total
Amount subtracts the urea total amount at the end of last time.Urea generate speed be urea incrementss divided by last time at the end of when starting to this
Time interval.Urea generates speed and is indicated with g, and the urea concentration of blood indicates that this dialysis is opened with Cs when this dialysis starts
Urea distribution volume when the beginning indicates that plasma wrea concentration is indicated with Cpe at the end of last time dialysis with Vs, and last time dialysis terminates
When urea distribution volume indicated with Vpe, time interval TIIt indicates, obtains following formula:
This urea distribution volume can be replaced by last time urea volume plus the body weight evolution during this, use Δ
BWi is indicated, is obtained urea and is generated speed g, obtains following formula:
The following are the project tables 2 that urea generates input parameter and output result that speed calculates:
| Patient's name | - |
| Dialysis time (hr) | Input |
| Dialysate flow (ml/min) | Input |
| Blood flow (ml/min) | Input |
| Body fluid volume (ml) | Input |
| Weight (kg) before dialysing | Input |
| Weight (kg) after dialysis | Input |
| Body weight evolution (kg) | Input |
| Urea clearance (mL/min) | Input |
| BUN (mg/dL) before this is dialysed | Input |
S203 calculates PCR: PCR:PCR can be obtained in the formula proposed after obtaining urea and generating speed g using Borah
=9.35g+11.04, PCR are protein decomposition rates, and g is that urea generates speed.
S204, calculating nPCR:nPCR is protein decomposition rate with weight come marking, referred to as Normalized protein catabolic rate,
NPCR=PCR/BW.Weight indicates that unit is kilogram with BW.
A technical concept, one embodiment of the invention are belonged to above-mentioned dialysis adequacy in chronic protein decomposition rate appraisal procedure
Provide dialysis adequacy in chronic protein decomposition rate assessment system.Fig. 3 is that the dialysis adequacy in chronic protein decomposition rate of the embodiment of the present invention is commented
Estimate system structure diagram.
As shown in figure 3, the dialysis adequacy in chronic protein decomposition rate assessment system of the embodiment of the present invention includes input unit 301,
Computing unit 302 and output unit 303；Input unit 301, for obtaining the last biochemical investigation data；Computing unit
302, urea distribution volume is calculated for the last biochemical investigation data according to acquisition, and be distributed according to the urea
Volume and specified parameter calculate urea and generate speed, further generate speed according to the urea and weight calculates mark
Standardization protein decomposition rate；Output unit 303, for showing the Normalized protein catabolic rate of output adequacy assessment.This is
It is to cooperate dialysis record by analysis data that system, which realizes algorithm part by algorithm software, calculates the dialysis adequacy in chronic of patient
Protein decomposition rate finally realizes ideal dialysis adequacy in chronic to reach optimum reelability quality after guaranteeing patients with hemodialysis.Consider different trouble
The individual instances of person keep calculated result consistent with practical protein breakdown situation.
What needs to be explained here is that input unit 301 is inputted for medical staff or computer-automatic collection patient
Clinical data.Computing unit 302, i.e. algorithm model module handle the patient clinical data received, pass through adequacy
The operation of the algorithm model of assessment obtains the adequacy assessment result of patients with hemodialysis, and the dialysis of patient is exported through output unit 303
The Normalized protein catabolic rate value of adequacy assessment.
A specific embodiment of the invention, referring to Fig. 3, which further includes storage unit 304, for storing every time thoroughly
The Normalized protein catabolic rate of analysis and corresponding diagnosis and treatment data.Storage unit 304 is used to store the history diagnosis and treatment of a large amount of patients
Data provide empirical historical data and model algorithm for computing unit 302 and carry out assessment operation for algorithm model mould module, and
Store patient per's dialysis adequacy in chronic assessment result, that is, by long-term hemodialysis patients' dialysis treatment and regular biochemical investigation number
According to collect and analyze, provide the appraisal procedure and algorithm of required critical evaluation index for doctor, with assist doctor realize to trouble
The correct treatment of person and best prognosis evaluation.
In practical clinical, if patient is to dialyse for the first time, algorithm model module utilizes largely to be suffered from memory module
The diagnosis and treatment data of person (include: name, gender, age, height, saturating age, weight, dialysis time, biochemical investigation data and dialysis letter
Cease data etc.), decision is compared, screens and is suitble to patient's Dialysis scheme for the first time, referred to for medical staff.
A specific embodiment of the invention, the input unit, specifically for inputting biochemical investigation by input interface
Data or the automatic collection biochemical investigation data from the medical system of biochemical investigation data.Here input unit is illustrated, it should
Unit be manually entered or automatic collection by way of to obtain the value of biochemical investigation data (include: urea before the date of inspection, dialysis
Phosphorus after phosphorus, dialysis before sodium, dialysis after sodium, dialysis before creatinine, dialysis after creatinine, dialysis before urea nitrogen, dialysis after nitrogen, dialysis, thoroughly
Potassium after potassium, dialysis before analysing) and dialysis parameters information data (include: the dialysis date, duration of dialysing, Hemodynamic environment, dialysate flow rate,
Weight, dialyzer urea clearance after weight, dialysis before weight, dialysis after last time dialysis), and above-mentioned data information is stored in
Storage unit.
A specific embodiment of the invention, the computing unit are specifically used for the last biochemical investigation according to acquisition
It includes: to obtain dialysis according to the dialysis data of regular analysis data and the chemical examination same day and open that urea distribution volume, which is calculated, in data
When the beginning and dialysis at the end of blood urea concentration, dialysis time, water removal, blood flow, urea removing coefficient；Initial urea point
Cloth volume uses an assumed value, calculates the urea concentration after dialysis starts per unit time at the end of dialysis, is somebody's turn to do
Urea concentration under the conditions of urea distribution volume；By constantly adjusting urea distribution volume assumed value, so that calculated urea
The urea concentration chemically examined at the end of concentration and dialysis is consistent, obtains actual urea distribution volume.
A specific embodiment of the invention, the computing unit are also used to according to the urea distribution volume and refer to
Determine parameter and calculate urea generation speed according to following formula:Wherein, g indicates that urea generates speed
Degree, Vs indicate urea distribution volume when this dialysis starts, and Cs indicates the urea concentration of blood when this dialysis starts, Vpe table
Show urea distribution volume at the end of the last dialysis, Cpe indicates the urea concentration of blood at the end of the last dialysis, TITable
Show this and the last time interval；Further speed and weight is generated according to the urea to calculate according to following formula
Normalized protein catabolic rate out: PCR=9.35g+11.04, nPCR=PCR/BW, wherein PCR is protein decomposition rate, and nPCR is
Normalized protein catabolic rate, BW are weight.
It should be noted that computing unit is to cooperate dialysis record by analysis data, the saturating of patient is gone out by four-step calculation
The Normalized protein catabolic rate of adequacy is analysed, it is final to realize ideal dialysis to reach optimum reelability quality after guaranteeing patients with hemodialysis
Adequacy.As shown in connection with fig. 2, above-mentioned four-step calculation include calculate urea distribution volume, calculate urea generate speed, calculate PCR,
Calculate nPCR.
In conclusion the system includes root the invention discloses dialysis adequacy in chronic protein decomposition rate appraisal procedure and system
Urea distribution volume is calculated according to the last biochemical investigation data of acquisition；According to the urea distribution volume and specify
Parameter calculates urea and generates speed；Speed is generated according to the urea and weight calculates Normalized protein catabolic rate；It is aobvious
Show the Normalized protein catabolic rate of output adequacy assessment.The embodiment of the invention provides a kind of eggs of hemodialysis patients
The white more accurate calculation method of resolution ratio, by the parsing to urea kinetic, using the urea clearance of dialyzer, thoroughly
The analysis time, Before and after dialysis blood urea nitrogen calculate urea distribution volume, so that the method for calculating protein decomposition rate, is examined simultaneously
The individual instances for considering different patients keep calculated result consistent with practical protein breakdown situation.Same invention is constituted with the above method
The system of design includes input unit, computing unit and output unit；Input unit, for obtaining the last biochemical investigation number
According to；Computing unit, for urea distribution volume to be calculated according to the last biochemical investigation data of acquisition, and according to described
Urea distribution volume and specified parameter calculate urea and generate speed, further generate speed and weight according to the urea
Calculate Normalized protein catabolic rate；Output unit, for showing the Normalized protein catabolic rate of output adequacy assessment.
Input unit is inputted for medical staff or the clinical data of computer-automatic collection patient, and computing unit is to the patient received
Clinical data is handled, and by algorithm operation, obtains the assessment result of patients with hemodialysis, is exported this dialysis through output unit and is filled
Divide the result of property.Computing unit of the embodiment of the present invention is to cooperate dialysis record by analysis data, and the dialysis for calculating patient is abundant
The Normalized protein catabolic rate of property finally realizes ideal dialysis adequacy in chronic to reach optimum reelability quality after guaranteeing patients with hemodialysis.
Compared with prior art, it is more accurately calculated by the protein decomposition rate that algorithm software system provides a kind of hemodialysis patients
Method, by the parsing to urea kinetic, using the urea clearance of dialyzer, dialysis time, Before and after dialysis blood
Urea nitrogen calculates urea distribution volume, thus the method for calculating protein decomposition rate, while considering the individual feelings of different patients
Condition keeps calculated result consistent with practical protein breakdown situation.
It will be understood by those skilled in the art that realizing all or part of the process of method in above-described embodiment, can pass through
Computer program controls relevant hardware to complete, and the program can be stored in computer readable storage medium.Wherein, institute
Stating computer readable storage medium is disk, CD, read-only memory or random access memory etc..
The foregoing is only a preferred embodiment of the present invention, but scope of protection of the present invention is not limited thereto,
In the technical scope disclosed by the present invention, any changes or substitutions that can be easily thought of by anyone skilled in the art,
It should be covered by the protection scope of the present invention.
Claims (10)
1. dialysis adequacy in chronic protein decomposition rate appraisal procedure, which comprises the following steps:
Urea distribution volume is calculated according to the last biochemical investigation data of acquisition；
Urea, which is calculated, according to the urea distribution volume and specified parameter generates speed；
Speed is generated according to the urea and weight calculates Normalized protein catabolic rate；
The Normalized protein catabolic rate of display output adequacy assessment.
2. the method according to claim 1, wherein this method further includes by the standardization of each dialysis adequacy in chronic
Protein decomposition rate and the storage of corresponding diagnosis and treatment data are in the database.
3. the method according to claim 1, wherein the last biochemical investigation data according to acquisition calculate
Include: to urea distribution volume
According to regular analysis data and chemical examination the same day dialysis data, obtain dialysis start when and dialysis at the end of blood urea
Concentration, dialysis time, water removal, blood flow, urea removing coefficient；
Initial urea distribution volume uses an assumed value, calculates the urea concentration after dialysis starts per unit time until dialysis
At the end of, obtain the urea concentration under the conditions of the urea distribution volume；
By constantly adjusting urea distribution volume assumed value, so that the urea chemically examined at the end of calculated urea concentration and dialysis
Concentration is consistent, obtains actual urea distribution volume；
Wherein, the last biochemical investigation data of the acquisition include by input interface input biochemical investigation data or from life
Change automatic collection biochemical investigation data in the medical system of inspection data.
4. method according to claim 1 or 3, which is characterized in that according to the urea distribution volume and specified parameter
Calculating urea generation speed includes:
The actual urea distribution volume when dialysing beginning is it is known that according to the urea concentration of blood when dialysis beginning and institute
The urea concentration and urea distribution volume of blood at the end of the last dialysis of acquisition are stated, and is calculated according to the following formula
Urea generates speed,
Wherein, g indicates that urea generates speed, and Vs indicates urea distribution volume when this dialysis starts, and Cs indicates that this dialysis is opened
The urea concentration of blood when the beginning, Vpe indicate urea distribution volume at the end of the last dialysis, and Cpe indicates the last dialysis
At the end of blood urea concentration, TIIndicate this and the last time interval.
5. according to the method described in claim 4, it is characterized in that, calculating mark according to urea generation speed and weight
Standardization protein decomposition rate includes:
Speed is generated according to the urea, and protein decomposition rate is calculated according to following formula,
PCR=9.35g+11.04
Wherein, PCR is protein decomposition rate；
According to the protein decomposition rate and weight according to following formula normalized protein decomposition rate,
NPCR=PCR/BW
Wherein, nPCR is Normalized protein catabolic rate, and BW is weight.
6. dialysis adequacy in chronic protein decomposition rate assessment system, which is characterized in that the system includes: input unit, computing unit and
Output unit；
Input unit, for obtaining the last biochemical investigation data；
Computing unit, for urea distribution volume to be calculated according to the last biochemical investigation data of acquisition, and according to institute
It states urea distribution volume and specified parameter calculates urea and generates speed, speed and body are further generated according to the urea
Re-computation goes out Normalized protein catabolic rate；
Output unit, for showing the Normalized protein catabolic rate of output adequacy assessment.
7. system according to claim 6, which is characterized in that the system further includes storage unit, for storing every time thoroughly
The Normalized protein catabolic rate of analysis adequacy and corresponding diagnosis and treatment data.
8. system according to claim 6, which is characterized in that the input unit is specifically used for defeated by input interface
Enter biochemical investigation data or the automatic collection biochemical investigation data from the medical system of biochemical investigation data.
9. system according to claim 6, which is characterized in that the computing unit is specifically used for according to nearest the one of acquisition
Secondary biochemistry inspection data is calculated urea distribution volume and includes:
According to regular analysis data and chemical examination the same day dialysis data, obtain dialysis start when and dialysis at the end of blood urea
Concentration, dialysis time, water removal, blood flow, urea removing coefficient；
Initial urea distribution volume uses an assumed value, calculates the urea concentration after dialysis starts per unit time until dialysis
At the end of, obtain the urea concentration under the conditions of the urea distribution volume；
By constantly adjusting urea distribution volume assumed value, so that the urea chemically examined at the end of calculated urea concentration and dialysis
Concentration is consistent, obtains actual urea distribution volume.
10. system according to claim 6 or 9, which is characterized in that the computing unit is also used to according to the urea
Distribution volume and specified parameter calculate urea according to following formula and generate speed:
Wherein, g indicates that urea generates speed, and Vs indicates urea distribution volume when this dialysis starts, and Cs indicates that this dialysis is opened
The urea concentration of blood when the beginning, Vpe indicate urea distribution volume at the end of the last dialysis, and Cpe indicates the last dialysis
At the end of blood urea concentration, TIIndicate this and the last time interval；
Speed and weight are further generated according to the urea and calculate Normalized protein catabolic rate according to following formula:
Wherein, PCR is protein decomposition rate, and nPCR is Normalized protein catabolic rate, and BW is weight.
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