血液透析对糖尿病肾病患者血糖及血压的影响

Impact of hemodialysis on blood glucose and blood pressure in patients with diabetic nephropathy

目的观察血液透析(HD)治疗对糖尿病肾病患者血糖、血压的影响,以及透析中静注高渗糖对患者血糖、血压的治疗效果。方法选择68例慢性肾功能衰竭维持性血液透析患者,其中38例糖尿病肾病和30例非糖尿病,均采用标准碳酸氢盐无糖透析液。均在餐后立即开始血液透析治疗,第1次观察HD期间不进食,分别于透析开始时、1h、2h、3h、HD结束时检测血糖值和血压变化情况;68例患者第2次血液透析至2h静脉推注50%葡萄糖60mL,记录透析结束时患者血糖值以及各时段血压动态变化情况。结果 HD至2h后,38例糖尿病肾病患者中有25例(占65.7%)出现低血糖;30例非糖尿病患者中有10例(占33.3%)出现低血糖;38例糖尿病肾病组发生18例低血压,占47.3%;30例非糖尿病患者中有7例出现低血压,占23.4%,两者比较差异有统计学意义(P<0.05)。于HD至2h给予静脉推注50%葡萄糖60mL,2次HD结束时血糖值比较差异有统计学意义(P<0.05);2次HD等时段收缩压、舒张压比较差异有统计学意义(P<0.05)。结论 HD过程中患者容易出现低血糖及透析相关性低血压,HD进行2h后,糖尿病肾病患者更易发生低血糖及透析相关性低血压。于HD至2h静脉推注50%葡萄糖可以防止低血糖及透析相关性低血压的发生。

Objective To observed the clinical effect of hemodialysis on blood glucose and blood pressure in patients with diabetic nephropathy, and observed the clinical effect of high permeability sugar with intravenous injection in blood glucose and blood pressure of patients. Methods Sixty eight patients fo chronic renal failure with hemodialysis were selected, 30 cases with diabetic nephropathy and 30 cases without diabetic nephropathy, all patients were given hemodialysis with Bi- carbonate sugar-free dialysis fluid. They were given hemodialysis after dinner at once, without food in the first HD time, the changes of blood glucose and blood pressure were detected in the beginning, 1 hour, 2 hours, 3 hours, finish of HD in hemodialysis; 68 patients were given 60 mL 50% Amylaceum with intravenous injection in the second hemodialysis in 2 hours later, the blood glucose levels and the changes of blood pressure were recorded in the finish of hemodialysis. Results HD for 2 hours, 25 cases of 38 patients with diabetic nephropathy in hypoglycemia （65.7%）; 30 cases without diabetic in hypoglycemia （33.3%）; there were 18 cases of 38 patient with diabetic nephropathy in hypoglycemia, accounted for 47.3%; 7 cases of 30 patients without diabetic in hypoglycemia, accounted for 23.4%, there were significant difference between two groups （P 〈 0.05）. HD for 2 hours, patients were given 60 mL 50% Amylaceum with intravenous injection, there were sig- nificant difference between the blood lueose of 2 times of finish of HD （P 〈 0.05）, there were significant difference be- tween the systolic blood pressure and diastolic pressure of 2 times of HD （P 〈 0.05）. Conclusion It is easy to find hypo- glycemia and intradialytic hypotension in patients during the HD, HD for 2 hours, hypoglycemia and intradialytie hypoten- sion are more common in patient with diabetic nephropathy. Giving 60 mL 50% Amylaceum with intravenous injection from HD to 2 hours can protect the occurrence of hypoglycemia and intradialytie hypotension.