晚期癌症患者水合状态与体征、症状及生存的关联——运用生物电阻抗矢量分析（BIVA）技术评估姑息治疗中的液体量：一项观察性研究
The Association of Hydration Status with Physical Signs, Symptoms and Survival in Advanced Cancer-The Use of Bioelectrical Impedance Vector Analysis (BIVA) Technology to Evaluate Fluid Volume in Palliative Care: An Observational Study.
作者信息
Nwosu Amara Callistus, Mayland Catriona R, Mason Stephen, Cox Trevor F, Varro Andrea, Ellershaw John
机构信息
Marie Curie Palliative Care Institute Liverpool (MCPCIL), University of Liverpool, Liverpool, United Kingdom.
Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, United Kingdom.
出版信息
PLoS One. 2016 Sep 27;11(9):e0163114. doi: 10.1371/journal.pone.0163114. eCollection 2016.
BACKGROUND
Hydration in advanced cancer is a controversial area; however, current hydration assessments methods are poorly developed. Bioelectrical impedance vector analysis (BIVA) is an accurate hydration tool; however its application in advanced cancer has not been explored. This study used BIVA to evaluate hydration status in advanced cancer to examine the association of fluid status with symptoms, physical signs, renal biochemical measures and survival.
MATERIALS AND METHODS
An observational study of 90 adults with advanced cancer receiving care in a UK specialist palliative care inpatient unit was conducted. Hydration status was assessed using BIVA in addition to assessments of symptoms, physical signs, performance status, renal biochemical measures, oral fluid intake and medications. The association of clinical variables with hydration was evaluated using regression analysis. A survival analysis was conducted to examine the influence of hydration status and renal failure.
RESULTS
The hydration status of participants was normal in 43 (47.8%), 'more hydrated' in 37 (41.1%) and 'less hydrated' in 10 (11.1%). Lower hydration was associated with increased symptom intensity (Beta = -0.29, p = 0.04) and higher scores for physical signs associated with dehydration (Beta = 10.94, p = 0.02). Higher hydration was associated with oedema (Beta = 2.55, p<0.001). Median survival was statistically significantly shorter in 'less hydrated' patients (44 vs. 68 days; p = 0.049) and in pre-renal failure (44 vs. 100 days; p = 0.003).
CONCLUSIONS
In advanced cancer, hydration status was associated with clinical signs and symptoms. Hydration status and pre-renal failure were independent predictors of survival. Further studies can establish the utility of BIVA as a standardised hydration assessment tool and explore its potential research application, in order to inform the clinical management of fluid balance in patients with advanced cancer.
背景
晚期癌症患者的补液是一个存在争议的领域；然而，目前的补液评估方法尚不完善。生物电阻抗矢量分析（BIVA）是一种准确的补液评估工具；但其在晚期癌症中的应用尚未得到探索。本研究使用BIVA评估晚期癌症患者的补液状态，以探讨液体状态与症状、体征、肾脏生化指标及生存之间的关联。
材料与方法
对英国一家专科姑息治疗住院单元中90例接受治疗的晚期癌症成年患者进行了一项观察性研究。除了评估症状、体征、体能状态、肾脏生化指标、口服液体摄入量和药物外，还使用BIVA评估补液状态。采用回归分析评估临床变量与补液之间的关联。进行生存分析以探讨补液状态和肾衰竭的影响。
结果
43例（47.8%）参与者的补液状态正常，37例（41.1%）“补液过多”，10例（11.1%）“补液不足”。补液不足与症状强度增加相关（β=-0.29，p=0.04），与脱水相关体征的得分更高相关（β=10.94，p=0.02）。补液过多与水肿相关（β=2.55，p<0.001）。“补液不足”患者的中位生存期在统计学上显著缩短（44天对68天；p=0.049），肾衰竭患者也是如此（44天对100天；p=0.003）。
结论
在晚期癌症中，补液状态与临床体征和症状相关。补液状态和肾衰竭是生存的独立预测因素。进一步的研究可以确定BIVA作为标准化补液评估工具的效用，并探索其潜在的研究应用，以便为晚期癌症患者液体平衡的临床管理提供依据。
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