限定最大超滤率对尿毒症维持性血液透析患者的影响

The Effects of Limiting the Maximum Ultrafiltration Rate on Uremic Patients with Maintenance Hemodialysis

目的:观察限制维持性血液透析患者的最大超滤率对透析低血压并发症及患者生活习惯的影响。方法:选取荆州市第一人民医院血液净化中心维持性血液透析患者98例,观察限制超滤率(最大超滤率不超过13mL/(kg·h))治疗前8周和限制超滤率后8周,限制超滤率后若患者需要达到干体重则延长单次透析时间或者增加血液透析次数。观察限制最大超滤率前后患者体重、血压、透析期间低血压等发生率的变化。结果:在限制最大超滤率之前,45例(45.9%)患者有超过3次血液透析最大超滤率大于13mL/(kg·h),超滤率最高达18.3mL/(kg·h)。制定该规定后,患者平均透析时间延长12min,26例患者增加透析次数47次(47/1824,2.58%)。限制最大超滤率后,患者透析前平均收缩压下降15mmHg(P<0.05),舒张压下降10mmHg(P<0.05),透析后平均收缩压下降与舒张压均下降10mmHg(P<0.05)。患者不限制最大超滤率,尿量丢失较快,而限制最大超滤率后,尿量丢失速度减慢(76.7±19.8mL/24hvs 126.5±38.6mL/24h,P<0.05)。通过制定该规定,患者生活习惯也改善,自觉限制水的摄入,体重增长明显减少(P<0.05)。透析期间低血压发生率也明显降低(2.74%vs 0.51%,P<0.05)。结论:透析中心制定限制最大透析超滤率可明显减少透析期间低血压发生率,患者血压得到较好控制。同时患者饮食习惯生改变,自觉限制水的摄入,但其长期效应需扩大样本量及多中心研究进一步证实。

Objective:To observe the effects of limiting the maximum ultrafiltration(UF)rate on hypotension complications caused by maintenance hemodialysis and life habits of the uremic patients.Methods:98cases of patients with maintenance hemodialysis had been selected in the hemodialysis centre of the First Hospital of Yangtze University,and curative effects had been observed 8weeks before and after limiting the UF rate,the maximum UF rate less than 13mL/(kg·h).If the patients had needed to reach target weights after limiting the UF rate,time of a single hemodialysis should been extended and frequencies of hemodialysis should been increased.Changes of weight,blood pressure and incidence of hypotension during hemodialysis had been observed before and after limiting the maximum UF rate.Results:45patients(45.9%)underwent hemodialysis more than three times with the UF rates more than 13mL/(kg·h),the highest UF rates up to 18.3mL/(kg·h).After limitation the average hemodialysis time extended to 12 min and the frequencies rose up to 47times(47/1824,2.58%).The average systolic pressure decreased by 15mmHg(P<0.05),the average diastolic by 10mmHg(P<0.05)before hemodialysis.Both the systolic and the diastolic decreased by 10mmHg(P <0.05)after hemodialysis.The urine loss decreased after limiting the maximum UF rate(76.7±19.8mL/24 hvs 126.5±38.6mL/24 h,P<0.05).Life habits of the patients were improved,water intake restricted voluntarily and weight gain decreased obviously.Incidence of hypotension during dialysis was reduced obviously(2.74%vs 0.51%,P<0.05).Conclusion:Limiting the maximum UF rate in hemodialysis centers results in the lower incidence of hypotension during hemodialysis and blood pressure can be controlled better.Meanwhile eating habits of the patients become better with water intake limited voluntarily.However long-term effects need to be proved further by enlarging samples and multicenter research.