氧疗联合低温血液透析对透析性低血压的影响

Effect of oxygen therapy combined with hypothermic hemodialysis on Intradialytic hypotension

目的探讨氧疗联合低温血液透析(hemodialysis,HD)对透析性低血压(intradialytic hypotension,IDH)的影响。方法选取84例HD患者,采用前后自身对照法分为2个阶段,Ⅰ阶段行单纯低温血液透析,Ⅱ阶段氧疗联合低温血液透析,均持续8周。2个阶段均分别监测透析过程中发生低血压的频率,并检测2阶段的生化和血气参数。结果氧疗联合低温血液透析明显降低了IDH的发作次数(从3.16±2.57到1.98±1.84,t=4.030,P=0.001)。血清白蛋白在2阶段存在微小差异,差异有统计学意义(Ⅰ、Ⅱ阶段分别为(33.2±2.9)和(32.3±2.5)g/L,t=2.154,P=0.033)。血气分析结果显示,与无氧疗阶段相比,氧疗显著降低了总二氧化碳(t=8.765,P<0.001)和碳酸氢根(t=10.820,P<0.001),提高了p H值(t=18.330,P<0.001)。结论氧疗联合低温血液透析对IDH有更好的疗效,且能在一定程度上维持HD中的代谢酸碱平衡。

Objective To investigate the effect of oxygen therapy combined with Hemodialysis(HD) on dialysis hypotension(IDH). Methods Eighty-four hemodialysis patients were selected and divided into two stages by self-control method. Stage Ⅰ was treated with simple hypothermic hemodialysis, stage Ⅱ oxygen therapy combined with hypothermic hemodialysis for 8 weeks. Two phases monitor the frequency of hypotension during dialysis and detect two-stage biochemical and blood gas analysis parameters. Results Oxygen therapy combined with hypothermic hemodialysis significantly reduced the number of episodes of IDH(from 3.16±2.57 to 1.98±1.84, t=4.030, P=0.001). There was a small difference in serum albumin between the two stages but it was statistically significant [stages Ⅰ and Ⅱ were(33.2±2.9) and(32.3±2.5)g/L, t=2.154, P=0.033]. The blood gas analysis showed that compared with the no oxygen therapy stage, Oxygen therapy significantly reduced TCO2(t =8.765, P<0.001) and HCO3-(t=10.820, P<0.001) and increased pH(t=18.330, P<0.001).Conclusion Oxygen therapy combined with hypothermic hemodialysis has a better effect on IDH and can maintain the metabolic acid-base balance in hemodialysis to a certain extent.