低钙透析液在伴有顽固性高血压血液透析患者中的应用

Clinical investigation of low-calcium dialysate in hemodialysis patients with refractory hypertension

目的探讨低钙透析液在伴有顽固性高血压血液透析患者中应用的有效性及安全性。方法选择40例伴有顽固性高血压的血液透析患者,随机分为A、B组,各20例。A组采用钙离子浓度1.75 mmol/L透析液透析治疗3个月;B组患者采用钙离子浓度1.75 mmol/L透析液透析治疗1周,换用钙离子浓度1.25 mmol/L透析液透析治疗1周,如此交替应用,共3个月。并观察比较患者透析前后血压、血钙、血磷及甲状旁腺激素(PTH)水平。结果与钙离子浓度1.75 mmol/L透析液组比较,使用钙离子浓度1.75 mmol/L与1.25 mmol/L透析组透后患者平均收缩压和舒张压均明显降低(P<0.05),大部分顽固性高血压患者血压下降,透析中高血压发生率也相应减少。无一例出现低血压状态。两组患者在透析前后,血钙、血磷和PTH差异无统计学意义(P>0.05)。结论对于伴有高血压的血液透析患者,恰当应用低钙透析液透析能有效纠正高血压,无低血压和低钙血症的发生。

Objective To investigate the clinical effect and safety of low - calcium dialysate in hemodialysis patients with refractory hypertension. Methods Forty hemedialysis patients with refractory hypertension were enrolled in this study and were randomly divided into groups A and B, 20 patients each. Group A patients received hemodialysis with the dialysate of 1.75mmol/L calcium for 3 months; Group B patients received hemodialysis with the dialysate of 1.75mmol/L calcium for 1 week, then received hemodialysis with the dialysate of 1.25mmol/L calcium for another l week. We observed the changes of blood - pressure（ BP）, serum calcium, serum phosphorus and PTH（parathyroid homone, PTH） in these patients. Results Compared with group A patients, patients of group B had lower mean systolic BP and lower mean diastolic BP（ P 〈 0. 05 ）. Most patients＇ refractory hypertension in group B was cured and none ofthem had hypotension. Compared with pre - dialysis, the level of serum calcium, serum phosphorus and PTH the two group patients had no sig- nificant change in post - dialysis. Conclusions Low - calcium dialysate improves the anti hypertensive effect in patients with refractory hy-pertension. No hypotension or low serum calcium occurred.