高钙透析液对维持性血透患者低钙、低血压的影响

Effect of High Calcium Dialysate on Low Calcium and Hypotension in Patients with Maintenance Hemodialysis

目的观察提高透析液钙浓度对低钙、低血压及透析充分性的影响。方法 2014—2017年选取该院透析中心维持性血液透析低钙伴低血压患者50例,先后应用普钙与高钙,各透析两周,分别记录各时间段血压、心率的变,比较血钙、Kt/V水平。结果高钙透析液组患者透中2 h、透中3 h、透后的收缩压和舒张压分别是(138.7±19.4)mmHg和(70.3±9.2)mmHg、(126.8±15.7)mmHg和(67.2±9.3)mmHg、(133.5±17.1)mmHg和(80.2±14.1)mmHg,较普钙组差异有统计学意义(t=3.444 7和4.107 2、7.448 9和6.385 2、14.771 6和12.788 6,P<0.05);高钙透析液组患者心率是(81.6±14.7)次/min,较普钙组差异有统计学意义(t=2.7850,P>0.05);普钙透析时不良反应发生率10%。2周后应用高钙透析液患者血钙为(2.29±0.06),Kt/V值为(1.38±0.13),较应用低钙透析液差异有统计学意义(t=36.769 5,15.318 1,P<0.05)。结论高浓度钙透析液可以升高血压,提高长期顽固低钙患者的血钙水平,减轻了患者的不适反应,保证了透析的顺利完成及毒素清除的充分性。

Objective To observe the effect of increasing the calcium concentration of dialysate on low calcium, hy-potension and dialysis adequacy. Methods A total of 50 patients with low blood pressure and low blood pressure inmaintenance dialysis patients in the hospital from 2014 to 2017 were selected. Calcium and high calcium were appliedsuccessively. The blood pressure and heart rate were recorded in each time period. Blood calcium and Kt/V level werecompared. Results The systolic and diastolic blood pressures of the patients in the high calcium dialysate group were（138.7±19.4）mmHg and （70.3±9.2）mmHg, （126.8±15.7）mmHg and （67.2±9.3）mmHg, （133.5±17.1）mmHg and（80.2±14.1）mmHg, respectively. There was a significant difference between the calcium group （t=3.444 7 and 2.107 2,7.448 9 and 6.385 2, 14.761 6 and 12.788 6, P〈0.05）. The heart rate of the high calcium dialysate group was （81.6±14.7）times/min, which was not significantly different from the calcium group（t=2.785 0, P〈0.05）; the incidence of ad-verse reactions during calcium dialysis was 10%. After 2 weeks, the calcium in patients with high calcium dialysatewas （2.29±0.06）, and the Kt/V value was （1.38±0.13）, which was significantly different from that of low calciumdialysate （t=36.769 5, 15.318 1, P〈0.05）. Conclusion High-concentration calcium dialysate can raise blood pressure,improve blood calcium level in patients with long-term stubborn low calcium, reduce the discomfort of patients, and en-sure the complete completion of dialysis and the sufficiency of toxin removal.