米多君加低温透析防治老年人血液透析相关性低血压15例疗效观察

Observation of Midodrine Plus Hypothermia Dialysis for the Aged Patients with Intradialysis Hypotension

目的探讨多种透析方法在老年人血液透析相关性低血压中的临床应用疗效。方法选择在我院血液净化中心规律治疗6个月以上、入选前2个月内的透析过程中有超过2/3的透析次数中发生低血压的老年维持性血液透析患者15例,所有观察对象均先按原透析方案行3周的透析,共129例次作为对照组(D组),后随机分为三组:米多君组(A组)、低温透析组(B组)及米多君+低温透析组(C组),每种治疗方法实施9周,共387例次,平均129例次/组。观察透析前、后血压、心率,透析过程中每30min测血压、心率,并计算平均动脉压(MAP),测量患者透析前后体温,观察并记录低血压发生的次数及时间、伴随症状、相关不良反应以及采取的护理干预。结果在降低低血压发生率方面,C组优于A组优于B组;在预防效果方面,C组最佳,A组、B组相比无显著差异;在稳定透析中的低血压方面,A组、B组效果相当,C组效果最佳。结论对于老年人血液透析相关性低血压,选用米多君+低温透析相结合的治疗方案,能够有效减少IDH的发作频率,保证透析的正常进行,而不良反应却无明显增加,值得临床推广应用。

Objective To evaluate efficacy of several treatments in intradialysis hypotension（IDH）in the aged maintenance hemodialysis patients（MDH）.Methods 15 MDH patients with IDH were included,who were given regularly dialysis in our blood purification center for more than 6 months,and more than 2/3 of the number of hypotension during dialysis for the first 2 months.All the subjects were given dialysis for three weeks as usual,a total of 129 cases times as the control group（D group）,randomly divided into three groups：midodrine group（A group）,hypothermia dialysis group（B group）and midodrine ＋ hypothermia dialysis group（C group）,Each treatment implement for nine weeks,a total of 387 cases,an average 129 cases meeting / group.The pre-dialysis、post-dialysis blood pressure,heart rate and temperature were measured and recorded,and measured every 30min during dialysis blood pressure,heart rate,and calculate the mean arterial pressure（MAP）.Observe and record the frequency and timing of hypotension,with symptoms related to adverse reactions and to take care intervention.Results In reducing the incidence of hypotension,C group was better than group A than group B;In the prevention effect and the stability of dialysis hypotension,C group is the best,A group,B group showed no significant difference.Conclusion Midodrine plus hypothermia treatment is effective in preventing the aged intradialysis hypotension and improving clinical symptoms for the patients.