血液透析患者低血压的临床研究

Clinial Research on Patients with Hemodialysis-associated Hypotension

目的探讨血液透析中低血压的发生机制及防治措施。方法收集40例长期血液透析患者的临床资料,按有无透析低血压分为低血压组(17例)及对照组(23例),比较两组病因、年龄、透析间期体重增长率;透析中超滤量(UFV)、超滤率(UFR);血钠(Na+)、白蛋白(Alb)、血红蛋白(Hb)、尿素氮(BUN)、血肌酐(Scr)。结果与对照组相比,合并糖尿病、左室肥厚及动脉硬化的老年人易发生透析低血压(P<0.01);透析间期体重增长率(%),透析中UFV、UFR有统计学差异(P<0.01);Na+、Alb、Hb有统计学差异(P<0.05);BUN、Scr差异无统计学意义(P>0.05)。结论控制透析间期体重增长、减慢超滤速度,改变血液净化方法,采用序贯钠透析、低温透析,适当用药,改善心功能,纠正贫血、低蛋白血症及营养不良等可防治透析中低血压。

Objective To explore the mechanisms, prevention and treatment of hypotension during hemodialysis. Methods The clinical data of 40 patients with maintaining hemodialysis were collected, they were divided into hypotension group （ n = 17 ） and control group （ n = 23 ） according to hemodialytic hypotension existing whether or not. The etiopathogenesis, age, weight growth rate in hemodialysis period, uhrafiltration（ UFV ）, ultrafiltration rate （UFR）, serum natrium （Na^＋ ）, albumin （Alb）, hemoglobin（Hb） ,blood urea nitrogren （BUN）, serum creatinnine （Scr） in hemodialysis period were compared between the two group. Results Compared with the control group, the aged complicated withdiabetes, left ventriculiar hypertroply, arteriosclerosic were apt to produce hemodialytic hypotension （P 〈0.01 ） ; the weight growth rate（ % ） , UFV, UFR existed statistic difference（ P 〈 0.01 ） ;there is also statistic difference between two group on Na^＋ , Alb, Hb （P 〈 0.05 ） ; but no difference existed on BUN, Scr （ P 〉 0.05 ）. Conclusions To prevent hypotension during dialysis, some measures should be taken： controlling weight growth rate between hemodialysis period, stepping clown the speed of uhrafihration, changing the method of blood purification, then adoptting the sequential natrium dialysate, cool dialysate, proper medicated and improving heart function, correcting anaemia, hypoproteinemia, cacotrophia, and so on.