传统维持性血液透析患者钠水平衡与高血压

Sodium and volume balance and control of blood pressurein traditional hemodialysis patients

目的 探讨传统维持性血液透析模式下透析患者钠水清除和高血压之间的关系.方法 血液透析组：3次/周,透析3个月及以上的维持性血液透析患者98例,收集人选病例最近1个月透析前的血压、血钠水平、脱水量占透析前体重的比例以及是否达到干体重等数据;未透析组：同期未进行过任何肾脏替代治疗的CKD4期、CKD5期所有住院患者118例,收集其入院当天的血压、血钠水平等.对组内和组间的数据以及与高血压之间的关系进行分析.结果 与未透析组相比维持性血液透析更好的控制了患者的血压（X2=10.767,P=0.001）.两组组内高血压和血钠水平无相关关系,两组患者高血压和血钠之间存在等级相关关系（rs=0.151,p=0.027）.透析组内达到干体重患者高血压的比例显著低于未达到干体重的患者（X2=16.450,P〈0.01）.结论 在低盐饮食的基础上,以超滤对流为主,配合以合适的透析液钠浓度弥散的方式为辅进一步完成对钠水的清除从而达到人体钠水平衡才是控制维持性血液患者高血压最重要的方案.

Objectives To investigate the relationship between hypertension and removal of sodium,extracellular volume in patients treated with traditional hemodialysis modality. Methods Hemodialysis group： all the patients in our hemodiaysis unit treated with traditional hemodialysis modality（3 times per week）for at least 3months were selected（n =98） , the values of blood pressure, serum sodium, proportion of weight loss to the weight before hemodialysis and the dry weight were registered. No dialysis group： all the in patients with CKD4 or CKDS who never received any modality of renal replacement therapy were selected （n = 118） , the values of blood pressure, serum sodium on the admission day were also registered. All the acquired data from each group were analysised and statistics with SPSS. Results Blood pressure was better controlled in hemodailysis patients compared with the patients in no dialysis group（X2 = 10.767, p =0.001）. Serum sodium correlate with hypertension in all the cases in 2 groups（re = 0.151, p =0.027） , but no relationship between them in each group. Blood pressure was lower in patients who have attained dry weight compared with patients who have not attained dry weight （X2 = 16.450, p 〈 0.01）. Conclusions Lower salt intake, convection depended on the prescribed ultrafiltration together with diffusion occurred across the dialyzer membrane based on the dialysate sodium and serum sodium consist the best protocol to attain the balance of systemic sodium and control the blood pressure in patients with traditional hemodalysis.