盐酸米多君治疗血液透析中低血压的多中心开放研究

An open mniticentre clinical trial for the treatment of intradialytic hypotension with midodrine hydrochloride

目的观察盐酸米多君对血液透析（HD）中低血压的疗效和安全性。方法选择4个地区8家HD中心符合HD中低血压诊断标准的维持性HD患者114例，进行为期4～6周盐酸米多君的口服治疗。用药方法：于HD开始后15～30min服用米多君2．5～10mg，若HD中收缩压升高幅度不足20mmHg，可增加药物剂量2．5～10mg，每次总量不超过20mg。每次HD前、HD中、HD后测定患者血压及心率，观察患者症状。每次HD前后测体质量、记录超滤量，检测肝肾功能、心电图。症状及程度评价采用5分制评分，并与盐酸米多君治疗前相比较。结果与盐酸米多君治疗前比较，患者HD中及HD后的最低收缩压、心率、总超滤量的差异有统计学意义（P〈0．01）。盐酸米多君治疗HD中低血压显效率8．8％，有效率24．6％，进步率50．9％，总有效率84．2％。头昏、胸闷、心悸等主要症状评分盐酸米多君治疗后与治疗前比较差异均有统计学意义（P〈0．01）。2例患者出现不良反应。结论盐酸米多君治疗HD中低血压是安全而有效的。

Objective To evaluate the efficacy and safety of midodrine hydrochloride in the treatment of intradialysis hypotension （IDH） in maintenance hemodialysis （MHD） patients. Methods One hundred and fourteen MHD patients from 8 dialysis centers with IDH were enrolled in the study. These patients took orally midodrine for 4-6 weeks. Midodrine （2.5-10 rag） was given 15-30 minutes after the beginning of hemodialysis, and another 2.5-10 mg was used during hemodialysis if systolic blood pressure （SBP） increased less than 20 mm Hg. The total usage of each dialysis session was not more than 20 mg. The pre-, intra-, post-hemodialysis blood pressure and heart rate, the pre- and post-hemodialysis body weight, the uhrafiitrated volume of each dialysis, the pre- and post-treatment liver and renal function and electrocardiogram were measured and recorded. The symptoms of IDH were observed. Results Compared to those before treatment with midodrine hydrochloride, the minimum intradialysis SBP and heart rate at that time, the post-dialysis SBP and heart rate, and total ultrafiitrated volume changed significantly （P〈0.01）. The total effective rate was 84.2%. And the symptoms of IDH were improved significantly （P 〈0.01）. The side effects were observed in only 2 patients. Conclusion Midodrine is safe and effective for the treatment of IDH.