生物自动反馈式血容量监测模式干预血液透析中低血压对维持性血液透析患者心功能的影响

Effects of biofeedback dialysis mode of blood volume monitoring on cardiac function in the maintenance hemodialysis patients with intra-dialytic hypotension

目的探讨生物自动反馈式血容量监测模式干预血液透析中低血压(IDH)对维持性血液透析(MHD)患者心功能的影响。方法选择2018年9月至2020年12月期间在南京医科大学附属苏州医院行维持性血液透析且多次发生透析低血压的患者40例。分为标准透析(SHD)组和生物自动反馈式血容量监测(BVM)组,每组各20例。第一阶段前12周两组患者均行标准透析,第二阶段后12周分别按照标准透析和生物自动反馈式血容量监测模式进行维持性血液透析治疗。观察两组患者透析低血压的发生率以及透析前后血压、体重、超滤量、B型脑利钠肽(BNP)、左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室后壁厚度(LVPW)、室间隔舒张期厚度(IVSD)、二尖瓣血流频谱E/A值(E/A)、左室质量指数(LVMI)的变化。结果(1)在第二阶段治疗中BVM组发生需要护理干预的透析低血压次数明显低于SHD组(P<0.05)。(2)BVM组患者在第二阶段治疗时的血压变化差明显小于第一阶段及SHD组(P<0.05)。(3)BVM组患者在第二阶段治疗时,超滤量较第一阶段明显增加,BNP、体重较第一阶段明显下降,差异均有统计学意义(均P<0.05),而SHD组患者在前后两阶段的治疗中体重、BNP及超滤量均无明显变化(均P>0.05)。(4)BVM组患者治疗前后心脏超声指标发生变化,LVEDD、LVPW、IVSD、LVMI较治疗前明显下降,LVEF、E/A较治疗前明显升高,差异均有统计学意义(均P<0.05),而SHD组患者的心脏超声指标治疗前后并无明显变化(均P>0.05)。结论生物自动反馈式血容量监测透析模式明显减少了透析低血压的发生,且此种透析模式可有效改善透析低血压患者的心功能情况。

Objective To discuss the effects of biofeedback dialysis mode of blood volume monitoring on cardiac function in the maintenance hemodialysis(MHD)patients with intra-dialytic hypotension(IDH).Methods 40 patients who underwent maintenance hemodialysis in Suzhou Hospital Affiliated to Nanjing Medical University from September 2018 to December 2020 and had IDH for many times were selected.They were divided into standard dialysis(SHD)group and biofeedback dialysis mode of blood volume monitoring(BVM)group,with 20 cases in each group.In the first 12 weeks of the first stage,the patients in both groups were treated with standard dialysis,and in the second 12 weeks,they were treated with maintenance hemodialysis according to standard dialysis and biofeedback dialysis mode of blood volume monitoring.The incidence of IDH and the changes of blood pressure before and after dialysis,body weight,ultrafiltration volume,B-type brain natriuretic peptide(BNP),left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD),left ventricular posterior wall thickness(LVPW),inlet ventricular septal defect(IVSD),mitral valve flow spectrum E/A value(E/A)and left ventricular mass index(LVMI)were observed.Results(1)In the second stage of treatment,the number of IDH requiring nursing intervention in BVM group was significantly lower than that in SHD group(P<0.05).(2)The difference of blood pressure change in BVM group during the second stage of treatment was significantly lower than that in the first stage and SHD group(P<0.05).(3)In the second stage of treatment,the ultrafiltration volume of patients in BVM group was significantly higher than that in the first stage,and the BNP and body weight were significantly lower than that in the first stage(all P<0.05).However,the body weight,BNP and ultrafiltration volume of patients in SHD group had no significan change in the two stages of treatment(all P>0.05).(4)After treatment,the LVID,LVPW,IVSD and LVMI in BVM group were significantly lower than those before treatment,and LVEF and E/A were significantly higher than those before treatment(all P<0.05).However,there was no significant change in echocardiographic indexes in SHD group before and after treatment(all P>0.05).Conclusions The biofeedback dialysis mode of blood volume monitoring can significantly reduce the occurrence of IDH,and this dialysis mode can effectively improve the cardiac function of MHD patients with hypotension.