苓桂术甘汤联合小剂量多巴胺在糖尿病肾病透析性低血压预防中的作用

Effect of Ling Gui Zhu Gan Decoction Combined with Low Dose Dopamie in Prevention of Dialysis Hypotension in Diabetic Nephropathy

目的:观察苓桂术甘汤联合多巴胺对终末期糖尿病肾病患者透析性低血压的预防作用。方法:22例行规律透析连续1个月且每次透析均出现低血压的终末期糖尿病肾病患者,按随机数字表法分为观察组和对照组各11例,所有患者继续给予规律性透析治疗3个月,第4个月开始对照组在透析开始时给予多巴胺,观察组患者在对照组基础上给予苓桂术甘汤。比较两组患者透析前、透析3 h以及透析结束3个时间点的收缩压平均值、舒张压平均值和动脉压平均值,比较两组患者前3个月和本次透析3个月发生透析性低血压的比例。结果:观察组用药3个月内发生透析性低血压比例为28.79%,显著低于对照组的100%,差异具有统计学意义(P<0.05)。用药后观察组透析3 h和透析结束后收缩压分别为(103.92±3.81)mm Hg(1 mm Hg=0.133 kPa)、(115.38±3.77)mm Hg,均高于对照组(91.69±3.74)mm Hg、(85.45±3.16)mm Hg,差异均有统计学意义(P<0.05)。用药后观察组透析3 h和透析结束后舒张压分别为(81.94±3.35、85.87±2.62)mm Hg,与对照组(75.12±3.24、70.16±2.59)mm Hg比较,差异均无统计学意义(P>0.05)。用药后观察组透析3 h和透析结束后动脉压分别为(89.26±3.30)mm Hg、(95.86±3.41)mm Hg,均高于对照组(80.12±3.11)mm Hg、(75.09±2.24)mm Hg,且差异均有统计学意义(P<0.05)。结论:苓桂术甘汤联合多巴胺对终末期糖尿病肾病透析患者有预防低血压的作用,有利于患者血压的稳定。

Objective： To observe the preventive effect of Ling Gui Zhu Gan Decoction combined with dopamine on dialysis hypotension in patients with advanced diabetic nephropathy. Methods： Twenty-one patients with end-stage diabetic nephropathy who underwent dialysis for 1 month with hypotension were divided into observation group and control group. All patients received regular dialysis treatment for first 3 months,after that control group was given dopamine while observation group was given Ling Gui Zhu Gan Decoction in addition. The mean value of systolic blood pressure,mean diastolic blood pressure and mean value of arterial pressure were compared before dialysis,at dialysis 3 h and at end of dialysis. Compare the differences of dialysis hypotension at first 3 months and the following 3 months. Results： The proportion of dialysis hypotension in the observation group was 28. 79%,which was significantly lower than that in the control group（ P〈0. 05）. After treatment,systolic blood pressure during dialysis for 3 h and after dialysis were（ 103. 92 ± 3. 81） mm Hg and（ 115. 38 ± 3. 77） mm Hg,which were higher than those in the control group（ 91. 69 ± 3. 74） mm Hg,（ 85. 45 ± 3. 16） mm Hg,the difference was statistically significant（ P〈0. 05）. Diastolic blood pressure during dialysis for 3 h and after dialysis were（ 81. 94 ± 3. 35,85. 87 ± 2. 62） mm Hg,compared with the control group（ 75. 12 ±3. 24,70. 16 ± 2. 59） mm Hg,the difference was not statistically significant（ P〈0. 05）. Arterial pressure during dialysis for 3 h and after dialysis were（ 89. 26 ± 3. 30） mm Hg,（ 95. 26 ± 3. 41） mm Hg,which were higher than those in the control group（ 80. 12 ± 3. 11） and（ 75. 09 ± 2. 24） mm Hg（ P〈0. 05）. Conclusion： Ling Gui Zhu Gan Decoction combined with dopamine has the effect of preventing hypotension in dialysis patients with advanced diabetic nephropathy,which is beneficial to the stability of blood pressure.