不同透析方式对血液透析时头痛发生的影响

Effect of different dialysis methods on headache during hemodialysis

目的探讨降低血液透析液流量及延长透析时长对血液透析时头痛的影响。方法选取2015年1月至2017年12月我院收治的150例维持性血液透析(MHD)患者,随机等分为观察组和对照组,观察组每次透析时间6~8h,透析液流量300ml/min,血流量150~200ml/min,每周透析3次;对照组每次透析时间4h,透析液流量500ml/min,血流量250ml/min,每周透析3次。比较两组患者透析6个月期间头痛发生情况、血液透析充分性及生活质量评分。结果透析6个月,观察组透析时头痛发生率为41.33%,明显低于对照组的60.00%(P<0.05);且观察组头痛VAS评分、头痛频率、头痛持续时间分别为(4.94±1.33)分、(6.87±1.64)次/月、(7.36±1.76)h/次,均明显低于对照组的(5.81±1.46)分、(8.31±1.89)次/月、(9.31±1.55)h/次,差异均有统计学意义(P<0.05)。观察组Kt/V值为(1.65±0.29)g/kg,对照组Kt/V值为(1.63±0.27)g/kg,组间比较差异无统计学意义(P>0.05)。透析6个月时,观察组躯体功能、情感功能、社会功能、总体生活质量评分均明显高于对照组,差异均有统计学意义(P<0.05)。结论降低血液透析液流量,延长透析时间能够有效减少血液透析时头痛发生率,改善患者生活质量,且不影响透析充分性。

Objective To explore the effect of reducing the flow of hemodialysis fluid and prolonging the duration of dialysis on headaches during hemodialysis. Methods We selected 150 patients with maintenance hemodialysis (MHD) who were admitted to our hospital from January 2015 to December 2017, and divided them randomly into observation group and control group with the same number of patients. The observation group was treated for 6 to 8 hours each time with the flow rate of 300 ml/min, and blood flow of 150~200 ml/min. The dialysis was conducted for 3 times per week. The control group was given dialysis for 4 hours each time with dialysate flow of 500 ml/min, and blood flow of 250 ml/min. The dialysis was conducted 3 times per week. The incidence of headache, hemodialysis adequacy and quality of life scores were compared between the two groups during the 6-month dialysis session. Results After dialysis for 6 months, the incidence of headache was 41.33% in the observation group, which was significantly lower than that of the control group, which was 60.00%( P <0.05). The VAS score, headache frequency and headache duration of the observation group were(4.94±1.33)points,(6.87±1.64)times/month, and(7.36±1.76) hours /time respectively. They were significantly lower than that of the control, which were (5.81±1.46) points,(8.31±1.89) times / month, and (9.31±1.55) hours / time.The differences were statistically significant( P <0.05). The Kt/V value of the observation group was (1.65±0.29) g/kg, and the Kt/V value of the control group was (1.63±0.27)g/kg. There was no significant statistical difference between the two groups( P >0.05).After dialysis for 6 months,the scores of physiological function,emotional function,social function and general health in the observation group were significantly higher than those in the control group,and the differences were statistically significant ( P <0.05). Conclusion Reducing the flow rate of hemodialysis solution and prolonging the dialysis time can reduce the incidence of headache during hemodialysis effectively and improve the quality of life of patients without affecting the dialysis adequacy.