血液透析时不同进食时间对患者血糖及血压的影响研究

The effect of different feeding time during hemodialysis on the blood glucose and blood pressure in nondiabetes patients:a randomized crossover trial

目的比较血液透析过程中不同进食时间对患者血糖及血压的影响。方法2018年6月—2019年10月,采用自身随机交叉对照设计,将40例非糖尿病肾病血液透析患者随机分配至2组。第1组前6次于血液透析1.5 h时进食,后6次于血液透析2.5 h时进食;第2组前6次于血液透析2.5 h时进食,后6次于血液透析1.5 h时进食。比较1.5 h进食组和2.5 h进食组血液透析前及血液透析1 h、2 h、3 h、4 h时的血糖和血压。结果最终纳入39例患者。在血液透析前及血液透析1 h、2 h、3 h、4 h每个时间点测量血糖和血压各234例次。1.5 h进食组血液透析2 h时低血糖发生率低于2.5 h进食组(χ^(2)=17.641,P<0.001)。两组在各时间点血糖值的比较,差异有统计学意义(F组间=5.32,F时间=28.65,F交互=19.62,均P<0.05),两组在各时间点低血压的发生率、收缩压、舒张压、脉压差的比较,差异无统计学意义(P>0.05)。1.5 h进食组血糖值在血液透析2 h、3 h时,显著高于2.5 h进食组,差异具有统计学意义(P<0.05)。结论采用无糖透析液进行血液透析的非糖尿病患者,相比2.5 h进食,1.5 h进食能减少低血糖的发生,且不增加低血压的发生。

Objective To evaluate the effect of different feeding time during hemodialysis using glucose-free dialysate on the blood glucose and blood pressure in non-diabetes patients. Methods A randomized crossover study was conducted. 40 patients were randomized to 2 groups:the first group taking food at 1.5 hour during hemodialysis for 6 sessions and then taking at 2.5 hour during hemodialysis for 6 sessions;the second group taking food at 2.5 hour during hemodialysis for 6 sessions and then taking at 1.5 hour during hemodialysis for 6 sessions.The blood glucose and blood pressure per hour during hemodialysis were measured. The incidence of hypotension and hypoglycemia at different time points were compared between the 1.5-hour feeding and the 2.5-hour feeding.Results 39 patients were finally included,and glucose and blood pressure were all measured 234 times at each 5 time points(before hemodialysis,1 h,2 h,3 h and 4 h during hemodialysis) in 2 groups. Compared with the 2.5-hour feeding,the incidence of 2 h during hypoglycemia in the 1.5-hour feeding was significantly lower( χ^(2)=17.641,P <0.001). There was no statistical difference in the incidence of hypotension,average systolic blood pressure,average diastolic blood pressure,and pulse pressure difference between 1.5-hour feeding and 2.5-hour feeding during the whole course of dialysis(P>0.05). The results of repeated measures analysis of variance showed that the levels of blood glucose were significantly higher at 2 h and 3 h in the 1.5-hour feeding than those in the 2.5-hour feeding(P<0.05). Conclusion Compared to feeding at 2.5 hours,feeding at 1.5 hours can reduce the incidence of intradialytic hypoglycemia,but it did not increase the incidence of intradialytic hypotension in non-diabetic patients using sugar-free dialysate.