左卡尼汀对维持性血液透析患者低血压的治疗作用

Effects of L-carnitine on maintenance hemodialysis patients with dialysis-related hypotension

目的观察静脉注射左卡尼汀(L-左旋肉碱)对维持性血液透析患者透析相关低血压的改善作用。方法选取19例稳定血液透析患者,进入研究前已接受维持性血液透析25个月以上,同时常规使用促红细胞生成素治疗。于每次血液透析后静脉注射左卡尼汀1.0g,疗程24周,维持使用原透析处方,采用自身治疗前后对比,观察患者透前血压、透中最低血压的变化和透析相关低血压的发生情况,以及血肌酐、尿素氮、白蛋白、电解质、血红蛋白及脱水量和透后体重的变化。结果 19例患者治疗前后血肌酐、尿素氮、白蛋白、电解质和血红蛋白差异无显著性,血压在治疗12周后明显改善(P<0.05)并达到稳态,透析相关低血压发生率明显降低(P<0.01),继续治疗12周后低血压发生率未再发生显著性变化;脱水量在12周后有增加,透后体重在12周后有下降,但均无显著性差异(P>0.05)。结论应用左卡尼汀可有效改善血液透析患者的低血压,但短期内患者的血肌酐、尿素氮、白蛋白、电解质、血红蛋白及脱水量和透后体重等无显著性变化。

Objectives To investigate whether the supplementation of L-carnitine to conventional therapy might improve dialysis-related hypotension. Methods Nineteen patients with maintenance hemodialysis （MHD） for more than 25 months were enrolled. L-carnitine 1.0g intravenously infusion was given after every hemodialysis session. The duration of this observational study was 24 weeks. The changes of blood pressure before hemodialysis,the peak blood pressure during hemodialysis and the occurrence of dialysis-related hypotension were compared before and after the intervention. Meanwhile,the changes of blood tests including serum creatinine（Scr）,blood urea nitrogen（BUN）,albumin（Alb）,hemoglobin（Hb）,concentration of K,Na,Ca,P,volume of dehydration and bodyweight after hemodialysis were recorded and analyzed. Results After 24 weeks of treatment,the blood tests did not have significant changes. The blood pressure improved significantly（P 0.05） and reached homeostasis in 12 weeks. The occurrence of hypotension during hemodialysis decreased significantly（P 0.01） in 12 weeks. Volume of dehydration increased after 12 weeks and bodyweight after hemodialysis decreased after 12 weeks,but the changes were all insignificant（P 0.05）. Conclusions Supplementation of L-carnitine can effectively improve the dialysis-reduced hypotention and has no effect on short-term renal function,albumin,electrolytes,hemoglobin,volume of dehydration and bodyweight after hemodialysis.