含糖透析液对非糖尿病透析相关低血压患者血压和舒适状况的影响

Effects of dialysate with glucose on blood pressure and comfort of patients with non-diabetic chronic hemodialysis associated hypotension

目的探讨含糖透析液对非糖尿病透析相关低血压患者血压和舒适状况的影响。方法采用前瞻性、交叉对照研究,对102例透析相关低血压患者应用无糖透析液和含糖透析液透析进行交叉透析。观察患者透析中血压(第1小时、第2小时、第3小时)和心率情况;并采用Kolcaba舒适度量表进行舒适度评价。结果在应用含糖透析液后,非糖尿病透析相关低血压患者透析中第1小时、第2小时、第3小时的收缩压明显升高,收缩压最小值明显升高,且收缩压下降最大值明显降低(P<0.01或P<0.05);透析中第1小时舒张压明显降低(P<0.01)。应用含糖透析液时有43例患者未再发生透析中低血压,其缓解率为42.16%。应用含糖透析液的非糖尿病透析相关低血压患者透析中第1小时、第2小时、第3小时的心率减慢(P<0.01或P<0.05)。应用含糖透析液的非糖尿病透析相关低血压患者舒适度总分和其心理、生理维度得分均增加(P<0.01或P<0.05)。结论含糖透析液可以明显改善维持性血液透析患者透析相关低血压,且提高患者的舒适度。

Objective To explore the effects of dialysate with glucose on blood pressure and comfort of patients with non - diabetic chronic hemodialysis associated hypotension （ CHD/non - DM）. Methods A total of 102 CHD/non - DM patients with intradialytic hypotension were involved in this prospective, self - cross - over control study. The blood pressure of patients in dialysis （ 1 h ,2 h and 3 h） and heart rate were collected. Patients＇comfort status was evaluated by Kolcaba Comfort Questionnaire （KCQ）. Results The level of minimum SBP value, maximum drop value of SBP in patients with glucose dialysate was increased in dialysis （ 1 h, 2 h and 3 h） （ P 〈 0.01 or P 〈 0.05 ） , and the level of minimum DBP value was decreased in dialysis one hour than those with glucose - free dialysate （ P 〈 0.01 ）. Fourty - three patients with glucose dialysate didnt suffer from intradialytic hypotension, with a remission rate of 42.16%. The HR in patients with glucose dialysate decreased in dialysis （1 h ,2 h and 3 h） than those with glucosefree dialysate （P 〈 0.01 or P 〈 0.05 ）. The overall comfort status including physical and mental dimensions in patients with glucose dialysate was significantly higher than those with glucose -free dialysate （P 〈 0.01 or P 〈 0.05 ）. Conclusion In CHD/non - DM patients, the use of dialysate with glucose counteracts intrdialytic hypotension and increases patients＇ comfort.