氧疗联合低温调钠模式在预防血液透析中低血压的效果观察

Effect of oxygen therapy combined with low temperature sodium regulation on the prevention of hypotension during hemodialysis

目的观察氧疗联合低温调钠模式在预防血液透析中低血压的临床效果。方法前瞻性选取2018年5月至2020年5月解放军联勤保障部队942医院肾内科行血液透析的60例患者作为研究对象,采用随机数字表法将患者分为低温调钠组与氧疗联合低温调钠组,每组各30例。低温调钠组给与低温调钠模式进行血液透析治疗,氧疗联合低温调钠组给予氧疗联合低温调钠模式进行血液透析治疗。比较两组预防低血压疗效、治疗过程中血压、血气指标[血液pH、二氧化碳总量(TCO_(2))、碳酸氢根(HCO_(3)^(-))和血氧饱和度]、电解质及Kt/V值。结果氧疗联合低温调钠组的预防血液透析中低血压总有效率为83.33%,明显高于低温调钠组(63.33%),差异有统计学意义(P<0.05)。透析中,氧疗联合低温调钠组中的收缩压和舒张压明显高于低温调钠组,差异均有统计学意义(P<0.05);低温调钠组透析前、透析中、透析后的收缩压和舒张压比较,差异均有统计学意义(P<0.05);氧疗联合低温调钠组透析前、透析中、透析后的收缩压和舒张压比较,差异均无统计学意义(P>0.05)。低温调钠组pH值在透析后明显高于透析前,氧疗联合低温调钠组透析后,pH、TCO_(2)、HCO_(3)^(-)值均优于透析前,差异均有统计学意义(P<0.05);透析后,氧疗联合低温调钠组中TCO_(2)、HCO_(3)^(-)值明显优于低温调钠组,差异均有统计学意义(P<0.05)。透析前和透析后,低温调钠组和氧疗联合低温调钠组中的Na+、K-比较,差异均无统计学意义(P>0.05),透析后,氧疗联合低温调钠组中Kt/V值明显高于低温调钠组,差异有统计学意义(P<0.05)。结论血液透析患者给予氧疗联合低温调钠模式血液透析治疗,是改善患者透析期间血压指标、血气指标的有效方案,对透析性低血压具有较好的预防作用,可予以推广。

Objective To observe the effect of oxygen therapy combined with low temperature sodium regulation on the prevention of hypotension during hemodialysis.Methods Sixty hemodialysis patients in the Department of Nephrology of China People's Liberation Army Joint Support Unit No.942 Hospital from May 2018 to may 2020 were prospectively selected as the research objects,they were grouped the low-temperature sodium modulation group and the oxygen therapy combined with low-temperature sodium modulation group by random number table method,30 cases in each group.The low-temperature sodium modulation group was treated with low-temperature sodium modulation mode for hemodialysis,and the oxygen therapy combined with low-temperature sodium modulation group was treated with oxygen therapy combined with low-temperature sodium modulation mode for hemodialysis,The curative effect of preventing hypotension,blood pressure,blood gas index[blood pH,total carbon dioxide(TCO_(2)),bicarbonate(HCO_(3)^(-))and oxygen saturation],electrolyte and Kt/V values during treatment were compared between the two groups.Results The total effective rate of preventing hypotension in oxygen therapy combined with low temperature sodium regulation group was 83.33%,which was significantly higher than that in low temperature sodium regulation group(63.33%),the difference were statistically significant(P<0.05).During dialysis,the systolic and diastolic blood pressure in the oxygen therapy combined with low-temperature sodium regulation group were significantly higher than that in the low-temperature sodium regulation group,the differences were statistically significant(P<0.05).There was significant difference in systolic and diastolic blood pressure before,during and after dialysis in the low-temperature sodium regulation group,the difference was statistically significant(P<0.05).There was no significant difference in systolic and diastolic blood pressure before,during and after dialysis in the oxygen therapy combined with low-temperature sodium regulation group(P>0.05).After dialysis,the pH value of hypothermic sodium regulation group was significantly higher than that before dialysis,the difference was statistically significant(P<0.05).After dialysis,the pH,TCO_(2) and HCO_(3)^(-)values of oxygen therapy combined with hypothermic sodium regulation group were better than those before dialysis,the differences were statistically significant(P<0.05);after dialysis,the values of TCO_(2) and HCO_(3)^(-)in oxygen therapy combined with low temperature sodium regulation group were significantly better than those in low temperature sodium regulation group,the differences were statistically significant(P<0.05).Before and after dialysis,there was no significant difference in Na+,K-between hypothermic sodium regulating group and oxygen therapy combined with hypothermic sodium regulating group(P>0.05).After dialysis,Kt/V values in oxygen therapy combined with hypothermic sodium regulating group was significantly higher than that in hypothermic sodium regulating group,the differences were statistically significant(P<0.05).Conclusion Hemodialysis patients are treated with oxygen therapy combined with low-temperature sodium regulation mode hemodialysis,which is an effective scheme to improve blood pressure and blood gas indexes during dialysis.It has a preventive effect on dialysis hypotension and can be popularized.