低钠透析联合血液透析滤过对尿毒症合并顽固性高血压患者血压节律、心功能及毒性代谢产物的影响

Effect of low-sodium dialysis combined with hemodiafiltration on the blood pressure rhythm,cardiac function as well as toxic and side metabolites in patients with uremia and resistant hypertension

目的分析低钠透析联合血液透析滤过对尿毒症合并顽固性高血压患者血压节律、心功能及毒性代谢产物的影响。方法 78例尿毒症合并顽固性高血压患者随机分为两组。对照组患者接受单纯血液透析治疗,观察组患者接受低钠透析联合血液透析滤过治疗。对比两组患者治疗4月后血压节律、心功能及毒性代谢产物等的差异。结果治疗4月后,观察组患者的24 h平均收缩压(24 h SBP)、24 h平均舒张压(24 h DBP)、日间平均收缩压(d SBP)、日间平均舒张压(d DBP)、夜间平均收缩压(n SBP)、夜间平均舒张压(n DBP)、心脏指数(CI)、心输出量(CO)、每搏量(SV)、舒张早期与晚期最大血流速度比值(E/A)、E峰与A峰流速积分比(EI/AI)均显著低于对照组患者,血浆中毒性代谢产物5-羟色胺(5-HT)、犬尿氨酸(KYN)、β2微球蛋白(β2-MG)、甲状旁腺激素(PTH)、肌酐(Cr)、尿素氮(BUN)含量也均显著低于对照组患者。结论低钠透析联合血液透析滤过可促进尿毒症合并顽固性高血压患者的血压节律恢复,在优化心功能的同时促进毒性代谢产物清除。

Objective To analyze the effect of low- sodium dialysis combined with hemodiafiltration on the blood pressure rhythm,cardiac function as well as toxic and side metabolites in patients with uremia and resistant hypertension. Methods 78 patients with uremia and resistant hypertension were randomly divided into observation group and control group,control group received hemodialysis therapy alone,observation group received low- sodium dialysis combined with hemodiafiltration therapy,and then the differences in blood pressure rhythm,cardiac function,toxic and side metabolites,etc were compared between two groups of patients after 4 months of treatment. Results After 4 months of treatment,24 h SBP,24 h DBP,d SBP,d DBP,n SBP and n DBP levels of observation group were significantly lower than those of control group,CI,CO,SV,E / A and EI / AI were significantly lower than those of control group,and 5- HT,KYN,β2- MG,PTH,Cr and BUN content in plasma were significantly lower than those of control group. Conclusion Low- sodium dialysis combined with hemodiafiltration can promote the recovery of blood pressure rhythm,optimize the cardiac function and also promote the removal of toxic and side metabolites in patients with uremia and resistant hypertension.