可调钠联合可调超滤模式和透析过程中钠的摄入改善透析低血压相关并发症的临床研究

The clinical study of joint adjustable sodium dialysis ultrafiltration mode and process of sodium intake improve the dialysis hypotension related complications

目的评价钠曲线联合超滤曲线的设定是否能减少透析低血压及相关并发症的发生率和不同钠浓度曲线设定对患者钠摄入及体重变化的影响。方法对长期维持性血液透析患者中透析低血压发生频率>20%的16例患者,采用前瞻性研究。每个患者均顺序经历3种透析模式,A组采用0超滤曲线及钠曲线;B组采用1超滤曲线及钠曲线(平均钠浓度为138 mmol·L-1);C组采用1超滤曲线及钠曲线(平均钠浓度为143 mmol·L-1);透析过程中监测透析液电导、血钠浓度、血压、尿素清除指数(KT/V)值及透析间期体重增长量等。结果①C组透析后血钠浓度较透析前升高(P<0.05),C组透析后血钠浓度与其他2组透析后钠浓度比较有差异有统计学意义(P<0.05);②C组透析后平均动脉压(MAP)比A组高(P<0.05);③B组和C组的低血压发生率与A组比较明显降低(P<0.05),B组比A组透析失败次数明显降低(P<0.05);④B组和C组的KT/V值较A组明显增高(P<0.05);⑤3组间透析间期体重增加量差异无统计学意义(P>0.05)。结论透析过程中,钠曲线联合超滤曲线的设定能减少透析低血压及相关并发症的发生率,而且不同钠浓度设定不引起透析间期体重的明显增加。

Objective To evaluate the joint adjustable sodium dialysis ultrafiltration mode and process of sodium intake in improving the dialysis hypotension related complications. Methods 16 long - term maintenance hemodialysis patients with hypotension frequency oc- curred more than 20% from the dialysis center of Ningxia People＇s Hospital were observe. The patients were divided into three groups： group A： 0 uhrafiltration profiling and sodium profiling;group B： 1 uhrafiltration profiling and sodium profiling （average sodium concentration of 138 mmol · L^-1 ） ;group C：1 ultrafiltration profiling and sodium profiling （average sodium concentration of 143 mmol· L^-1 ）. During dialysis,we monitored the dialysate conductivity, sodium concentration, blood pressure, KT/V values, as well as the body weight gain between dialysis. Results The serum sodium concentration increased in group C after dialysis compared with predialysis （P 〈0. 05） ,and the serum sodium con- centration in group C after dialysis also were higher than that in group A and B （P 〈 0.05）. The mean arterial pressure （MAP） in group C after dialysis were higher than that in group A （P 〈 0. 05） ;The incidence of hypotension;dialysis failure in group B and C were significantly lower than that in group A （P 〈 0.05）. The KT/V value in group C and B were higher than that in group A （P 〈 0. 05）. There were no significant difference in weight gain between dialysis in three groups （P 〉 0. 05）. Conclusion During dialysis, sodium profiling combined uhrafiltration profiling setting can reduce the incidence of dialysis hypotension and complications,but doesnt affect the weight gain between dialysis.