低温血液透析联合左卡尼汀预防透析相关性低血压的疗效观察

Clinical Observation on Low-temperature Hemodialysis Combined with Levocarnitine in Preventing Intradialytic Hypotension

目的观察低温血液透析联合应用左卡尼汀预防透析相关性低血压的疗效。方法选择12例患者,其中男性4例,女性8例,年龄45～78岁。原发病:慢性肾小球肾炎8例,糖尿病肾病4例。入选常规:在我院血液透析6个月以上,血液透析中低血压发生率50%以上,Hb≥80g/L,Hct≥30%,无其他严重并发症。使用常温血液透析、低温血液透析及应用左卡尼汀联合低温血液透析3种方式治疗,通过比较血液透析中血压的变化,观察3组血液透析相关性低血压发生次数。结果 3组患者血液透析前血压差异无统计学意义(P>0.05),血液透析中治疗组血液透析后血压高于对照组。血液透析相关性低血压发生次数在2个治疗组均显著低于对照组,但经t检验低温血液透析组与常温常温组比较无统计学意义,P>0.05;而低温联合左卡尼汀治疗组低血压发生明显低于常温血液透析组和低温血液透析组,经比较具有统计学意义,P<0.05;同时均未发现血液透析患者原有心脏病症状的恶化。结论左卡尼汀和低温血液透析可显著降低血液透析相关性低血压发生率,改善血液透析相关性低血压相关症状,两者联合应用可进一步提高疗效,无明显不良反应。

Objective To observe the efficiency of low-temperature hemodialysis combined with levocarni-tine in preventing intradialytic hypotension.Methods Choose 12 cases,in which there were 4 male and 8 female,age： 45-78 years old.The primary affection：8 cases with chronic glomerulonephritis,and 4 cases with diabetic nephropathy. Selected routine：The patients have been dialyzed for more than 6 months in our hospital;the incidence rate of hypotension in hemodialysis was over 50%;and Hb≥80 g/L,Hct≥30%;there was no other severe complication.Through three kinds of ways,hemodialysis at ordinary temperature,low temperature and hemodialysis combined with levocarnitine,to treat intradialytic hypotension;through comparing the changes of blood pressure in hemodialysis to observe the frequency of intradialytic hypotension in three groups.Results There was no statistical significane on blood pressure of patients in three groups before hemodialysis（P〉0.05）,and after hemodialysis the blood pressure of treatment group was higher than that of control group.The frequency of intradialytic hypotension in two treatment groups was lower than that in control group,but through t-test there was no statistical significance compared between hemodialysis groups at low temperature and ordinary temperature（P〉0.05）.While,the frequency of hypotension in the treatment group by low-temperature hemodialysis combined with levocarnitine was significantly lower than that of hemodialysis at ordinary temperature and low temperature;through the comparison there was statistical significances（P〉0.05）;there were not any deterioation of previous heart disease symptoms in hemodialysis patients.Conclusion Levocarnitine combined with hemodialysis at low-temperature could significantly decrease the frequency of levocarnitine,improve the related hypotension symptoms.The combination of two groups could further improve the efficiency without significant adverse reactions.