维持性血液透析并发低血压的临床分析

Clinical Analysis of Hypotension in Chronic Hemodialysis

目的:探讨维持性血液透析并发低血压的相关因素及机理。方法:对82例醋酸盐血液透析超过1个月的慢性肾功能衰竭(CRF)患者进行统计学分析。结果:11486例次透析并发低血压236次,绝大多数低血压发生在超滤量>2L及透析时间>2h时。结缔组织病相关性肾损害、血红蛋白≤70g/%、左室舒张末期直径(LVEL)≥55mm者,低血压发生率高于其他病因的肾损害、血红蛋白>70g/L、LVED<55mm组。结论:透析低血压是多因素作用的结果,包括超滤量及透析时间,醋酸盐对心血管的抑制作用,结缔组织病引起的血管炎降低血管的顺应性,严重贫血及心功能不全等。

Objective:To explore the hypotension-related factors and their pathogenesis in chronic hemodialysis. Methods: Data about 82 CRF patients treated with acetate hemodialysis for more than one month were analyzed statistically. Results: Two hundred and thirty-six times of hypotension occurred in 11,486 times of hemodialysis,in which more than half of them oc-curred in the case of dialyzed liquid mount >2 L and 2 hours later. The occurrences of hypotension in groups of renal dam-age associated with connective tissue disease,Hb≤70 g/L,LVED≥55 mm were significantly higher than those in control groups (P<0.01 respectively).Conclusion:The hypotension in chronic hemodialysis was involved in many factors,such as the restraints of dialyzed liquid amount,time of hemodialysis and acetate' restraint on cardiovascular function,decreased vas-cular compliance due to connective tissue disease-related vasculitis,severe anemia and cardiac insufficiency. In order to pre-vent the occurrence of hypotension in chronic hemodialysis, these hypotension-related factors must be treated carefully.