中心静脉压在评估老年维持性血液透析患者超滤量的意义

Roles of central venous pressure on evaluating ultrafiltration volume in old patients receiving maintenance hemodialysis

目的研究中心静脉压(CVP)在调节超滤量中的作用。方法对44例老年维持性血液透析患者进行对照研究,22例对照组根据体重增量估算超滤量,另22例观察组在此基础上,根据CVP的变化来调节超滤量,对两组低血压、肌肉抽搐、心力衰竭发生率,以及6个月前后SBP、DBP、心胸比例(CTR)、下腔静脉直径/体表面积(VCD)进行比较。结果观察组患者低血压、肌肉抽搐及心力衰竭发生率分别为11.41%、9.39%、2.14%,低于对照组的26.16%、14.29%、3.75%,差异均有统计学意义(χ2分别=112.75、18.12、7.10,P均<0.05)。6个月前后比较,观察组除DBP外,6个月后SBP、CTR及VCD分别为(131.30±12.09)mmHg、(0.53±0.05)及(11.89±3.29)mm/m2,均低于6个月前的(164.45±29.39)mmHg、(0.58±0.08)及(14.10±3.78)mm/m2,差异均有统计学意义(t分别=4.89、2.50、2.07,P均<0.05),对照组6个月前后SBP、DBP、CTR及VCD比较,差异均无统计学意义(t分别=0.08、0.43、0.48,P均>0.05)。结论以CVP结合体重增量调节老年MHD患者超滤量,可降低透析过程中低血压、肌肉抽搐发生率,并能改善患者SBP、CTR、VCD等容量相关指标。

Objective To explore the roles of central venous pressure on adjusting uhrafiltration volume in old patients receiving maintenance hemodialysis. Methods Forty-four old patients receiving maintenance hemodialysis were investigated. Uhrafihration volume was estimated by weight increment in half of them （control group）, and by weight increment combined with CVP in the other （observation group）. Then, the incidence of hypotension, spasm, heart failure, and systolic blood pressure （SBP）, diastolic blood pressure （DBP）, cardiothoracic ratio （CTR）, inferior vena cava diameter-body surface area ratio （VCD） were detected within six months. Results The incidences of hypotension, spasm and heart failure were significantly lower in the observation group than those in the control group, 11.41%,9.39%,2.14%,vs 26.16%,14.29%,3.75%（x2=112.75,18.12,7.10,P〈0.05）. The levels of SBP,CTR,VCD were markedly decreased in the observational group six months later , from （164.45±29.39） mmHg, （0.58±0.08）, （14.10± 3.78） mm/m2 to （131.30±12.09） mmHg, （0.53±0.05）,（11.89±3.29） mm/m2 （t=-4.89,2.50,2.07,P〈0.05）. Conclusions It could decrease the incidences of hypotension, spasm and heart failure that adjusts uhrafihration volume by means of weight increment combined CVP, and improve the indiees such as SBP, CTR and VCD in old patients receiving maintenance hemodialysis.