血液透析联合灌流改善透析相关性高血压的研究

The Effect of Hemoperfusion Combined with Hemodialysis on Intradialytic Hypertension

目的探讨血液灌流对尿毒症维持性血液透析(MHD)患者体内血管紧张素Ⅱ(ATⅡ)变化影响及透析相关性高血压的改善。方法选择符合透析相关性高血压的尿毒症患者20例先后行血液透析及血液透析串联血液灌流(HD+HP),观察治疗前、后血压的变化。将血压变化的差值进行自身对照研究。比较血液透析前后及血液灌流串联血液透析前后血管紧张素Ⅱ及甲状旁腺激素水平的变化。结果透析相关性高血压患者在行HD+HP时平均动脉压(MAP)无明显升高,P>0.05透析前后血压无明显变化;血液灌后血管紧张素Ⅱ及甲状旁腺激素水平有所下降P<0.05,差异有统计学意义。结论常规血液透析时,血中ATⅡ水平升高,与患者透析相关性高血压有一定关联。血液透析串联血液灌流可清除ATⅡ及PTH等引起血压升高的中分子毒素,减少了透析相关性高血压的发生。

Objective To investigate the effect of hemoperfusion on intradialytic hypertension and the change of serum An- giotensin- Ⅱ （AT Ⅱ）.Methods 20 patients with intradialytic hypertension ,take the blood pressure before and after hemodialysis （HD）and HD eombied hemoperfusion （HP）.Test the serum level of ATⅡ before and after HD and HD＋HP treatment.Results MAP didn＇ t increase obviously during HD combied HP, serum level of AT Ⅱ decreased after the treatment of HD combied HP（P〈0.05）. Conclusion Serum level of AT Ⅱincreased during HD,but can＇ t be removed by HD.It is related to intradialytic hypertension. HD combied HP can remove AT 1Ⅱand PTH, reduce the incidence of intradialytic hypertension.