Midodrine和低温血液透析对透析中低血压的防治作用

The effect of midodrine and cool dialysate on symptomatic in tradialytic hypotension

目的 观察α1肾上腺素能受体激动剂米多君(midodrine)和低温血液透析(coolhemodialysis ,CHD)对透析中顽固性低血压(IDH)的防治作用。方法 应用前瞻性交叉设计,将12例IDH患者先后采用4种治疗方式,即空白对照、midodrine、CHD以及联合治疗。观察血压、IDH干预次数、输注盐水量以及IDH相关症状严重程度的变化。结果 4组中透析前血压相似,3种治疗组的最低血压均显著高于对照组(P <0 .0 1) ,透析后血压与上述结果相似。IDH症状评分、生理盐水输入量以及IDH干预次数在3种治疗组均显著低于对照组(均P <0 .0 5 ) ,联合治疗组最低血压明显高于midodrine组和CHD组(均P <0 .0 5 ) ,未发现研究组间原有心脏病症状的恶化。结论 midodrine和CHD均可显著降低IDH发生率,改善IDH相关症状;两者联合应用可以进一步提高疗效,无明显副作用,值得临床推广。

Objective To investigate the the rapeutic efficacy of both midodrine, an oral selective α 1 agonist, and cool dialysate on int radia lytic hypotension (IDH). Methods This prospective crossover st udy consisted of a control phase and three therapy phases: midodrine phase (5 mg oral dose pre-H D ), cool dialysate phase (35.6℃), and combination therapy phase (midodrine 5 mg , and cool dialysate temperature of 35.6℃). Each phase consisted of nine consec utive H D treatments. 12 patients with k nown symptomatic IDH were studied. This cohort was followed up in terms of blood pressure measurements (pre-HD blood pressure, lowest intradialytic blood press u re, post-HD blood pressure), laboratory values and interventions for IDH. Results Pre-HD blood pressures were similar during all four p hases. The lowest int r adialytic blood pressures were significantly higher with midodrine, cool dialysa te and combination than the control phase (all P<0.001), as were the post-H D blood pressure. In addition, the lowest intr adialytic bl ood pressure were significantly higher in combination with midodrine and cool dialysate dialysis than midodrine or cool dialysate alone (all P<0.05),howe ver, there is no significant differences between the different tre atmen t phases in post-HD blood pressure. There was a significant reduction in the num b er of interventions performed and volume of saline infusion for IDH with midodri ne, cool dialysate and combination compared with control. Conclusions This study shows that both midodrine and cool di alysate are effective therapies for symptomatic IDH, and there is additional ben efit when these two therapies are used in combination.