可调钠透析对维持血容量的作用

Effects of sodium profile on the maintenance blood volume during hemodialysis and ultrafiltration

目的 :观察可调钠透析对血钠浓度的影响以及对维持有效血容量的作用。方法 :对稳定的维持性血液透析病人各进行 4h的普通透析 (conventionalhemodialysis,CHD ,透析液Na+浓度 138mmol·L-1)和可调钠透析(sodium profilehemodialysis,PHD ,透析液Na+浓度由 148mmol·L-1线性下降到 135mmol·L-1) ,匀速脱水 ,病人自身对照 ,CHD和PHD时血流速相等 ,脱水量相当。透析过程中监测透析液电导、血钠浓度、红细胞压积、血容量、血压、心率变化 ,下次透析前记录透析间期体重增长量。结果 :PHD透析过程中血钠逐渐升高 ,2h达高峰 ,随后逐渐恢复透析前水平。CHD血容量下降速度明显高于PHD。PHD能更好地维持血压。CHD和PHD透析间期体重增长量差异无显著性。结论 :与CHD相比 ,PHD能有效维持透析脱水过程中的血容量 ,并有维持收缩压的作用。PHD的这种作用不以增加病人的钠负荷为代价 ,不造成透析间期增重过多。

Objective:Tt study effects of sodium profile on blood sodium concentration and on blood volume change. Methods:15 stable patients (6 males and 9 females) aged 65.47±8.85 years on maintenance hemodialysis were studied. Each patient received both conventional hemodialysis (CHD, dialysate =138 mmol·L -1 ) and hemodialysis with sodium profile (PHD, dialysate decreased from 148 mmoL·L -1 to 138 mmol·L -1 linearly), ultrafiltration rate kept constant during both CHD and PHD, 4 hours per session. Patients were self controlled, blood flow rate was individualized and the same blood flow rate was used during CHD and PHD; there was no significant difference of ultrafiltration between CHD and PHD(2.35±1.02 verse 2.42±0.87, P =0.75). Fresenius 4008B or 4008E dialyzing machines and polysulfone membrane dialyzer (Fresenius F6) was used. Dialysate conductivity, and blood sodium concentration were determined every hour; hematocrit, and blood volume change were monitored with blood volume monitor; blood pressure, and heart rate were recorded every 0.5 hours; Interdialytic weight gain was recorded before next dialysis.Results: Plasma sodium concentration increased gradually during PHD and reached its peak value [(143.73±4.61) mmol·L -1 ) 2 hours after the beginning of dialysis,and then decreased gradually and returned to perdialysis valuev (predialysis 138.93±4.68 mmol·L -1 , postdialysis 138.97±6.05 mmol·L -1 , P =0.96). Plasma sodium concentration remained unchanged during CHD. There was great difference in blood volume decrease, 13.42%±5.59% for CHD and 8.72%±6.55% for PHD group. PHD maintained blood pressure better than CHD. There was 1 case of vomiting and 1 case of muscle spasm in CHD group and there was no such sign in PHD. There was no difference in interdialytic weight gain between these 2 groups (CHD 2.40± 0.88, PHD 2.47±0.70, P =0.58). [WTHZ]Conclusion: It was concluded that compared with CHD, PHD could slow blood volume decreasing rate during ultra filtration; this helped to maintain blood pressure. Blood volume preserving effect of PHD is not at the expense of sodium overload.