被动抬腿试验和停止超滤对血液透析患者透析相关性低血压的影响

Effect of passive leg raising trial and suspended ultrafiltration on hemodialysis-related hypotension in hemodialysis patients

目的观察被动抬腿(PLR)试验和停止超滤对血液透析相关低血压患者的影响。方法采用随机自身交叉对照研究设计,记录并比较52例血液透析低血压患者PLR、停止超滤的血压变化和超滤目标情况。结果所有患者在实施PLR、停止超滤前的血液透析时收缩压(SBP)、舒张压(DBP)、心率比较,差异无统计学意义(P> 0.05)。发生低血压时,PLR与停止超滤均可升高血压,在实施10 min后均可明显升高SBP,差异有统计学意义(P <0.05)。采用PLR 10、20、30 min时,DBP升高的差异有统计学意义(P <0.05或P <0.01),停止超滤对DBP无影响。PLR与停止超滤均可以接近达成血液透析净脱水目标,但实际超滤量均较预设超滤量减少,差异有统计学意义(P <0.05)。结论血液透析患者发生低血压时,可以采取PLR和停止超滤升高血压。PLR既能升高血压,也能达到目标超滤量。

Objective To observe the effect of passive leg raising( PLR) trial and suspended ultrafiltration in patients with hemodialysis-related hypotension. Methods A randomized,self-designed and crossover controlled study was adopted,and the changes of blood pressure and the target of ultrafiltration after PLR and suspended ultrafiltration were recorded and compared in 52 patients with hemodialysis-related hypotension. Results There were no significant differences in systolic blood pressure( SBP),diastolic blood pressure( DBP) and heart rate before implementation of PLR and suspended ultrafiltration between the two groups( P > 0. 05). When hypotension occurred,PLR and suspended ultrafiltration were able to increase hypertension,and SBP significantly increased at 10 minutes after implementation( P < 0. 05). When PLR was used for 10,20 and 30 min,the DBP significantly increased( P < 0. 05 or P < 0. 01),and suspended ultrafiltration has no effect on DBP. PLR and suspended ultrafiltration were close to complete the goal of net dehydration in hemodialysis,but the actual ultrafiltration volume was significantly less than the preset ultrafiltration volume( P < 0. 05). Conclusion When hypotension occurs in hemodialysis patients,PLR and suspended ultrafiltration can increase blood pressure. PLR can not only increase blood pressure,but also achieve the target ultrafiltration volume.