可调钠配合低温透析防治高危患者透析低血压研究

A Study on the High-risk Patients with Dialysis Hypotension Prevented Through Sodium Profile in the Low Temperature

目的观察可调钠配合低温透析在高危人群(高龄、糖尿病肾病、肿瘤及心功能不全等)血液透析中防治低血压的作用。方法选择10例维持性血液透析中的高危患者透析,透析模式:常规常温组(A组):透析液温度37℃,透析液钠浓度140mmol/L;调钠+常温(B组):透析液温度37℃,透析液钠浓度由148～155mmol/L线性下降至透析结束时135mmol/L;调钠+低温组(C组):透析液温度35.5℃～36℃,透析液钠浓度由148～155mmol/L线性下降至透析结束时135mmol/L。每例患者每种模式观察10次,两者血流速度相等,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3组透析模式相比,透析前后血清钠浓度无明显差异(P>0.05)。就低血压发生率而言,A组和B组模式相比较,卡方检验有统计学差异(χ2=12.58,P<0.005);A组和C组模式相比较,卡方检验有统计学差异(χ2=16.89,P<0.005);B组和C组模式相比较,卡方检验无统计学差异(χ2=0.39,P>0.05)。与常规透析相比,可调钠透析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。结论可调钠透析可明显减少维持血液透析中高危人群的低血压的发生率。低温结合可调钠透析对低血压的预防作用并不明显优于单纯可调钠透析。

Objective Intradialytic hypotension （IDH） is a morbid complication of hemodialysis （HD） , which frequently happened in the high-risk groups （high-age, diabetic nephropathy, cancer, cardiac insufficiency, etc. ）. In this paper the author investigates the effect of sodium profile dialysis in low temperature on controlling hypotension. Methods Ten uremic high-risk patients receiving regular bicarbonate hemodialysis were chosen as examples. Hemodialysis patterns：constant sodium hemodialysis（CHD） , high-low sodium hemodialysis （H-LHD）, and combina- tion therapy phase （H-LHD, and cool dialysate）. In CHD, sodium concentration of the dialysate was 140 mmol/L. In H-LHD, sodium concentration of the dialysate in the beginning of dialysis was 148 - 155 mmol/L, and remain constant for 60 min. Sodium concentration of the dialysate changed according to a model to keep identical when the amount of dialysate sodium exchanged in the different dialysis porocedures. At the end of dialysis the sodium concentration was 135 mmol/L. In low temperature phase, it was 35.5℃ - 36℃, which was different from the 37℃ in the other two phases. Each phase consisted of ten consecutive HD treatment. The duration of hemodialysis, the blood flow rate, the dialysate flow rate, and the dialysis membrane were the same for all three different hemodialysis modalities. Total dialysate collection and intradialytic sodium balance were calculated for each hemodialysis session. Results The resuits have shown that in the three different hemodialysis treatments phases there were no statistically difference between sodium concentration of the dialysis before and after the dialysis （ P 〉 0.05 ）. There was a significant reduction in the amount of IDH in the H-LHD alone and that combinated with cool dialysate compared with control group. There was a trend loward improvement of hypotensive symptoms by both therapies. Conclusion This prospective study shows that PHD is effective therapies for symptomatic IDH. It does not show the additional benefit when these two therapies are used in combination.