透析液钠浓度对尿毒症患者血压和心脏功能的影响

Effects of dialysate sodium concentration on blood pressure and heart function in uremic patients

目的:了解相对性低钠透析对尿毒症患者血压和心脏功能的影响及其安全性。方法:选择合并高血压的维持性血液透析患者120例并随机分为A、B两组。A组透析液钠离子浓度减为135 mmol/L,B组给予常规透析,透析液钠离子浓度142 mmol/L。观察透析8周后两组患者血压、体重、血清尿素氮、肌酐、体重指数、K t/V值、左室射血分数(LVEF)的变化,比较两组患者透析期间不良反应的发生率。结果:两组患者在年龄、体重、性别比例、透析时间、及研究前血压、血清尿素氮、肌酐、K t/V、LVEF和BM I方面差异均无显著性(P>0.05)。A组患者在治疗后收缩压[(158.2±11.1)vs(156.8±10.0)mmHg,P<0.05]、舒张压[(88.1±9.4)vs(85.6±8.6)mmHg,P<0.01]和体重[(55.1±7.0)vs(54.7±6.5)kg,P<0.05]较治疗前均显著降低,患者LVEF较治疗前显著增加[(53.5±6.7)%vs(54.1±5.4)%,P<0.05],但血清尿素氮、肌酐、K t/V和BM I较治疗前差异无显著性(P>0.05)。B组患者治疗后上述各指标较治疗前差异均无显著性(P>0.05)。A组患者透析时低血压[5.96%vs3.48%,P<0.05]和透析失衡(3.65%vs1.59%,P<0.05)的发生率显著高于B组,透析时高血压、低血糖、心律失常和心力衰竭的发生率两组间差异无显著性(P>0.05)。结论:相对性低钠透析可有效降低血压和改善患者心脏功能,但增加透析时低血压和透析失衡的发生率,因而在临床应用时要加强防护措施。

Objective： To investigate the effects and safety of relatively low sodium dialysate in uremic patients. Methodology：One hundred and twenty uremic patients with hypertension were randomly divided into A and B group. In A group, patients were treated with low sodium dialysate hemodialysis （ sodium concentration 135 mmol/L） for 8 weeks. In B group, patients were treated with common sodium dialysate hemodialysis （sodium concentration 142 mmol/L） for 8 weeks. The blood pressure, body mass, body mass index, serum urea nitrogen and creatinine, Kt/V and left ventricular ejection fraction （LVEF） were compared between two groups before and after eight-week treatment. The safety of low sodium dialysate hemodialysis was also evaluated by analysing dialysis adverse reactions between two groups. Results：Clinical data of two groups had no statistical difference before treatment. However, after 8 weeks treatment for A group patients, the blood pressure and body mass were decreased marketly, and their LVEF was improved significantly. Other indexes in A group and all indexes in B group had no statistical changes when compared with that before the treatment. Patients of A group had higher incidence rate of intradialysis hypotension and dialysis disequilibrium symptom when compared with B group, and no statistical difference was found in other adverse reactions between two groups. Conclusion：Relatively low sodium dialysate hemodialysis is valid to eliminate water-sodium retention, decrease blood pressure and improve cardiac function in uremic patients. But it may increase the incidence of intradialysis hypotension and dialysis disequilibrium symptom.