不同血液透析模式对透析中低血压的影响

Influence of different dialysis modes on hypotension during hemodialysis

目的比较低温＋超滤曲线HD、钠曲线＋超滤曲线HD、低温＋钠曲线HD、低温＋钠曲线＋超滤曲线HD、常规HD＋上机前口服米多君与常规HD在透析过程中低血压发生的情况。方法对经常出现血液透析相关性低血压的20例维持性血透患者，依次实施常规HD、低温＋超滤曲线HD、钠曲线＋超滤曲线HD、低温＋钠曲线HD、低温＋钠曲线＋超滤曲线HD、常规HD＋上机前口服米多君，每人每种方式实施四周的治疗剂量，观察比较6种模式透析低血压的发生情况。结果低温＋超滤曲线组、钠曲线＋超滤曲线组、低温＋钠曲线组低血压的发生率低于常规组（P〈0．05），低温＋超滤曲线＋钠曲线组、上机前口服米多君组低血压的发生率显著低于常规（P〈0．01），低温＋超滤曲线组、钠曲线组＋超滤曲线、低温＋钠曲线组，之间比较低血压的发生率无差异（P〉0．05），低温＋超滤曲线＋钠曲线组与上机前口服米多君组低血压的发生率无差异（P〉0．05），低温＋超滤曲线组、钠曲线组＋超滤曲线、低温＋钠曲线组与低温＋超滤曲线＋钠曲线组、常规透析＋上机前口服米多君组之间低血压的发生率经统计学处理均有显著差异（P〈0．01）。结论在体重增长、超滤率大致相等情况下，低温＋超滤曲线＋钠曲线组与常规HD＋上机前口服米多君组低血压的发生率在统计学无意义（P〈0．01），提示这两种透析模式预防透析相关性低血压的效果最佳，可以根据患者的经济及对透析模式的耐受情况具体选择。

Objective Low- temperature ＋ UF curves HD, sodium curve ＋ UF curves HD, low- temperature ＋ sodium curve HD, low - temperature ＋ sodium curve HD ＋ UF curves HD, HD ＋ oral administration of mldodrine before dialysis and conventional HD were comprised to observe hypotension occurrence during hemodialysis. Methods Twenty patients were selected who occurred related hypotension frequently. They were treated with the following proposals： conventional HD, low - temperature ＋ UF curves HD, sodium curve ＋ UF curves HD, low - temperature ＋ sodium eurve HD, low - temperature ＋ sodium curve ＋ UF curves HD, conventional HD ＋ oral administration of midodrine before dialysis. Each patient＇s treatments lasted four weeks under each dialysis mode. The incidence of hypotension were observed and compared among six dialysis modes. Results The incidence of hypotension in low - temperature ＋ UF curves, sodium curve ＋ UF curves, low - temperature ＋ sodium curve groups were lower than that of （ P 〈 0.05 ）, the incidence of hypotension in low - temperature ＋ sodium curve ＋ UF curves, oral administration of midodrine before dialysis groups were significant lower than that of conventional group （P 〈0. 01） . The incidences of hypotension among low- temperature ＋ UF curves HD group, sodium curve ＋ UF curves group and low - temperature ＋ sodium curve group were no difference （ P 〉 0. 05） . The incidences of hypotansion between low - temperature ＋ sodium curve ＋ UF curves group and oral administration of midodrine group were no difference （P 〉0. 05） . There was significant difference by statistical treatment on incidences of hypotension between low - temperature ＋ UF curves group, sodium curve ＋ UF curves group, low- temperature ＋ sodium curve group and low- temperature ＋ sodium curve ＋ UF curves group, conventional HD ＋ oral ad- ministration of midodrine before dialysis group （P 〈 0. 01 ） . Conclusions The incidences of hypotension in low - temperature ＋ sodium curve ＋ UF curves group and conventional HD ＋ oral administration of midodrine before dialysis group were no statistical significance （ P 〈 0. 01 ） . It hints that the effect of preventing dialysis - related hypotansion is the best under two modes. The patients can choose these modes according to their economy and endurance.