可调钠透析防治高危血液透析患者低血压研究

Prophylactic Effect of Sodium Modeling Hemodialysis on Dialysis Hypotension in High Risk Patients

目的:观察可调钠透析(PHD)在高危人群(高龄、糖尿病肾病及心功能不稳定)血液透析中防治低血压的作用。方法:选择30例维持性血液透析中的高危患者透析,治疗分两阶段进行,第1月行普通透析(CHD)为A组,透析液钠浓度138 mmol/L,第2月行可调钠透析(PHD)为B组,透析液钠离子浓度由148 mmol/L,线性下降到135 mmol/L,透析时间均4.5 h,患者自身交叉对照,两者血流速相等,脱水量恒定,透析过程中监测透析前后血清钠浓度,监测透析过程中低血压发生率。结果:CHD组与PHD组相比,透析前后血清钠浓度无明显差异(P>0.05)。CHD组与PHD组相比,PHD组低血压发生率较CHD组明显降低(P<0.01)。与CHD相比,PHD的作用以不增加患者的钠负荷为代价,不造成透析间期体重增长过多。结论:PHD组可明显减少维持血液透析中高危人群的低血压的发生率。

Objective：To assess the prophylactic effect of sodium modeling hemodialysis on hypotension during hemodialysis in patients with high risk factors（elderly, diabetic nephropathy and cardiac insufficiency）. Methods： 30regnlar hemodialysis patients with above risk factors was employed, Under the conditions of same blood flow and constantul trafiltration volume, all patients were performed conventional hemodialysis（CHD） at the first month wth the sodium concertation of Hemodialysis fluid 138mmol/L（A group） and sodium profile hemodialysis（PHD） at the second month with the sodium concertation of Hemodialysis fluid reduced from 148 mmol/L to 135mmol/L（B group）, the serum concertations of sodium were detected pre - Hemodialysis and post - Hemodialy- sis ,respectively, the occurrence of hypotension during Hemodialysis was also observed during Hemodialysis. Results： （ 1 ）compared with group B, no obvious difference of serum sodium concextatlon occurred between pre - Hemodialysis and post - Hemodialysis in group A （P〉 0.05）, （2）the occurrence rate of hypotension in group B was significantly reduced compared with group A（P 〈 0.01）, （3） compared with group A, PHI） plays its therapeutic role without the increase of sodium burden and body weight.Conclu- sion： sodium modeling hernodialysis can obviously prevent the occurrence of dialysis hypotension in patients with high risk factors.