低钠透析对合并顽固性高血压尿毒症患者血压和心脏功能的影响

Effects of low sodium dialysis on blood pressure and heart function in uremic patients with refractory hypertension

目的探讨相对性低钠透析对合并顽固性高血压的尿毒症患者血压和心脏功能的影响及其安全性。方法将合并顽固性高血压的维持性血液透析患者80例随机分为2组,A组透析液钠离子浓度为135 mmol/L,B组透析液钠离子浓度为140 mmol/L。观察透析6周后2组患者血压、体质量、血清尿素氮(BUN)、肌酐(SCr)、K t/v值、左房内径(LAD)、左室舒张末内径(LVDd)、左室收缩末内径(LVD s)、左室射血分数(LVEF)的变化,比较2组患者透析期间不良反应的发生率。结果 A组患者在治疗后收缩压、舒张压、LAD、LVDd、LVD s和体质量较治疗前均显著降低,LVEF较治疗前显著增加,但血清尿素氮、肌酐和K t/v无显著变化。B组患者治疗后上述各项指标与治疗前比较均无显著性差异。A组患者透析时高血压的发生率显著低于B组,透析时低血压、低血糖、心律失常、透析失衡和心力衰竭发生率2组间比较无显著性差异。结论相对性低钠透析可有效降低血压和改善患者心脏功能,合并顽固性高血压的尿毒症患者短期使用安全有效。

Objective It is to discuss the effects and safety of relatively low sodium dialysis in uremic patients with refractory hypertension.Methods Eighty uremic patients with refractory hypertension were randomly divided into 2 groups.In group A sodium concentration of dialysate was 135 mmol/L,and that of group B was 140 mmol/L.The changes of blood pressure,bodymass,serum BUN and SCr,Kt/v,LAD,LVDd,LVDs and LVEF were observed in both groups after 6 weeks＇ dialysis,and the occuring rates of side effect during dialysis stage between the two groups were compared.Results After 6 weeks＇ treatment in group A,the blood pressure,bodymass,LAD,LVDd and LVDs were decreased markedly after treatment,and their LVEF was improved significantly,but no significant change of serum BUN,SCr and Kt/v were found.Compared with that before treatment,there was no significant difference in the indexes above after treatment in group B.Incidence rate of hypertension during dialysis in group A was significantly lower than that in group B,and no statistical difference was found in other adverse reactions such as hypotension,hypoglycemia,arrhythmia,dialysis disbalance and heart failure between two groups.Conclusion Relatively low sodium dialysate hemodialysis can effectively low down blood pressure and improve patient＇s heart function,it is safe and effective to treating for uremic patients with refractory hypertension.