维持性血液透析患者透析相关性低血压的防治

Prevention and treatment of hemodialysis-related hypotension in patients with maintenance hemodialysis

目的 分析透析相关性低血压发生的病因,探讨针对主要病因进行个体化透析治疗在降低低血压发生率中的重要性.方法 对血液透析过程中发生低血压的21例患者进行自身前后对照分析,前1个月收集低血压患者的病因资料,第2个月为调整分析期,运用柏拉图分析法结合鱼骨图解析,找出低血压主要病因,针对主要病因进行宣教及调整治疗方案；第3个月再次统计低血压发生率及具体病因,比较干预治疗前后低血压发生率及病因的变化.结果 低血压主要病因是脱水量/干体重＞5％、糖尿病、透析过程中进餐、透析前不合理服用降压药物等,21例患者干预前后2个月共行血液透析534例次,干预后低血压发生率明显下降,干预前后低血压发生率分别为7.7％ （39/260）和3.3％（9/274）,两组比较差异有统计学意义（P＜0.01）.透析相关性低血压多出现在透析后3小时.结论 对不同患者寻找低血压病因,针对主要病因进行重点宣教及个体化透析,可明显降低血液透析过程中低血压的发生率.

Objective To investigate the main causes of hemodialysis-related hypotension and explore the importance of individualization dialysis aiming on the main causes for reducing the incidence rate of hypotension.Methods Twenty-first patients with hemodialysis-related hypotension were recruited,and their clinical data were analyzed before and after the treatment.In the first month,the data of hemodialysis-related hypotension were collected;The second month was the the adjust and analysis period,By applying the method combined Platon analysis with the fishbone diagram analysis,the main causes of hypotension were investigated,and then education was developed and treatment was adjusted;In the third month,the incidence rates and the specific causes of hypotension were analyzed,incidence rate and etiological changes of hypotension were compared before and after the intervention.Results The major cause of hypotension was dewatering amount/dry weight ＞ 5％,diabetes,having meal during hemodialysis,and taking antihypertensive drugs before hemodialysis.534 rounds of hemodialysis proceeded in 21 patients before and after the intervention.The incidence rate of hypotension decreased significantly,The incidence rate of hypotension before and after intervention was 7.69％ （39/260）and 3.3 ％ （9/274）,respectively.The difference was significant（P ＜ 0.01）.Hemodialysis-related hypotension often occurred 3 hours after hemodialysis.Conclusions It is important for various patients to search for specific causes of hypotension.Education and individualized dialysis can significantly reduce the incidence of hypotension during hemodialysis.