不同钠曲线结合超滤曲线对透析相关低血压的预防作用

Prevention of different sodium curves combined with ultrafiltration curve on dialytic related hypotension

目的观察不同形式钠曲线结合超滤曲线对透析相关低血压的预防作用。方法选取我院血液净化中心易发生低血压(既往2月发生低血压频次为>30%)患者23例,随机分为四组:对照组(C组)5例、线性曲线组(L组)6例、阶梯曲线组(S组)7例,脉冲曲线组(P组)5例,对照组进行普通透析,其余三组分别给予线性、阶梯、脉冲三种不同形式的钠曲线结合超滤曲线治疗。每组患者按交叉设计分别进入上述四组,每组进行12个透析周期,重复检测各项指标,中间不进行洗脱,依次进入下一组,直至所有干预进行完成。结果四组透析前、后血钠浓度比较,差异无统计学意义(P>0.05)。L组和S组低血压发生率均明显低于C组(P<0.05);P组与C组低血压发生率比较,差异无统计学意义(P>0.05)。透析过程平均动脉压变化曲线中,C组低血压多发生在透析末期(T_5),L、S、P组在T_5的平均动脉压较C组明显更高。结论透析相关低血压多发生于透析末期,采用线性或阶梯式钠曲线结合超滤曲线后,可明显减少透析相关低血压的发生率,同时提高透析末平均动脉压。

Objective To observe the prevention of different sodium curve combined with ultrafiltration curve on dialysis related hypotension. Methods A total of 23 patients prone to hypotensive （the frequency with hypotension in the past 2 months was above 30%） in our blood purification centerwere selected and randomly divided into 4 groups： control group （C group） of 5 cases was treated with normal dialysis; linear curve intervention group （L group） of 6 cases, steps curve intervention group （S group） of 7 cases and pulse curve intervention group （P group） of 5 cases were given three different forms of linear, steps, pulse ultrafiltration curve combined with sodium curve treatment respectively. Patients were crossdesigned respectively into the above four groups. Each group was given 12 dialysis cycles, indicators were tested repeatedly and turn to the next group successively without elution until all the intervene finished. Results There were no statistical differences in the serum sodium levels before and after dialysis among the four groups （P〉0.05）. The incidences of hypotension in the L group and S group were significantly lower than that in the C group （P〈0.05）. There was no significant difference in the incidences of hypotension between the P group and C group （P〉0.05）. The curves of mean arterial pressure showed that dialysis related hypotension tend to occur at the end of dialysis （T5） in the C group. The mean arterial pressure at T5 in the L, S and P group were significantly higher than that in the C group. Conclusion Dialysis related hypotension tends to occur at the end of dialysis. The methods of combination of linear or steps sodium curves combined with ultrafiltration curves can significantly reduce the occurrence rate of dialysis related hypotension and improve the average arterial pressure at the end of dialysis process.