调节透析液钾浓度对血液透析患者电解质紊乱和心血管稳定性的影响

The effect of regulating the potassium concentrationof the dialysateon the electrolyte disorder and cardiovascular stability in patients with hemodialysis

目的探讨调节透析液钾浓度对血液透析患者电解质紊乱和心血管稳定性的影响。方法选取大埔县人民医院行维持性血液透析的患者15例共707次透析,其中69例次行高钾透析液透析治疗作为观察组,选择每例患者行高钾透析治疗前5次透析共75例次为对照组;分别采用含钾浓度为3.0-4.0 mmol/L、2.0-2.5 mmol/L的透析液进行透析治疗。测定透析前后两组患者K＋、Na＋、CL-的浓度,并记录心血管并发症发生情况。结果透析后,对照组K＋浓度明显降低,为（3.03±0.05）mmol/L,且显著低于观察组的（3.74±0.08）mmol/L,差异有统计学意义（P〈0.05）;观察组Na＋、CL-浓度显著升高,而对照组无明显变化,两组比较差异有统计学意义（P〈0.05）。观察组血压下降和心律失常的发生率分别为7.25%和15.94%,均显著低于对照组的36.00%和46.67%（P〈0.05）。随访1年后,观察组心率正常和动脉硬化指数均显著优于对照组,差异有统计学意义（P〈0.05）。观察组患者心慌、胸闷及气促的发生率均显著低于对照组,差异有统计学意义（P〈0.05）。结论电解质紊乱、血压下降和心律失常是血液透析治疗中的常见并发症,临床上若采用3.0~4.0 mmol/L钾浓度的透析液进行透析可有效纠正电解质紊乱和维持心血管稳定性。

Objective To discuss the effect of regulating of thepotassium concentrationof dialysateon the electrolyte disorder and cardiovascular stability in patients with hemodialysis. Methods 15 cases of 707 times emodialysis patients were randomly selected in People＇s Hospital at Dapu and divided into observation group （69 times） undergoing high potassium dialysis and control group（75 times） with five times dialysis before high potassium dialysis,administrating dialysate with potassium concentration of 3.0-4.0 mmol/L and 2.0-2.5 mmol/L, respectively. The serum levels of K^＋, Na＋, and Cl- were measured before and after dialysis, and the occurrenceof cardiovascular complications was recorded. Results The serum level of K^＋ was significantly decreased after dialysis,and the level of the control group [（3.03± 0.05）mmol/L] was significantly lower than that of the observation group [（3.74±0.08）mmol/L] （P〈0.05）.The serum levels of Na^＋, and C1- were significantly increased in observation group, while no significant changes in control group.The serum levels of Na＋ ,and C1- were significant difference between two groups （P〈O.OS）.Mter high potassium dialysis treatment, the incidence rates of low blood pressure （7.25%） and arrhythmia （15.94%） were significantly lower than those of low potassium dialysis treatment （low blood pressure,36.00%;arrhythmia,46.67% ,P〈0.05）.Mter follow-up 1 year, heart normal rate and athcrosclerosis index of observation group were significantly better than those of control group （P〈0.05）.And in terms of adverse reactions, there were significant difference between two groups of palpitation,chest tightness and shortness of breath（P〈0.05）. Conclusion Electrolyte disorder, decreased blood pressure and arrhythmia are the common complication in hemodialysis treatment, and the application of dialysate with 3.0-4.0 mmol/L potassium cancorrect electrolyte disorder and maintain the cardiovascular stability effectively.