应用超滤曲线和血容量监测预防透析反应的护理研究

Nursing Research of Ultrafiltration Profiling and Measurement of Relative Blood Volume as Strategies to Reduce Hemodialysis-Related Side Effects

目的 观察采用不同超滤(ultrafiltration,UF)曲线模式对血液透析症状性低血压发生的影响,并评估相对血容量(relative blood volume,RBV)监测对血透症状性低血压的预报作用。方法 选择68例既往有血透症状性低血压的血透患者,分别应用6种不同超滤曲线模式,共进行238次透析。UF0(超滤率恒定),UF1(超滤率呈线性递减),UF2(阶梯式超滤率下降),UF3～UFS(高超滤率与最小超滤率交替),并监测RBV值的变化。结果 采用UF0和UF1曲线模式时症状性低血压发生率均明显低于UF2、UF3、UF4、UF5曲线模式,其中UF1曲线模式发生率最低;与UF0和UF1模式相比,肌肉痉挛、呕吐、疲劳、头痛在UF2～UF5有较高的发生率。发生低血压症状时患者RBV常低于无症状时的RBV。临界最小相对血容量(mRBV)一般低于88％时,预示可能有症状性低血压的发生。结论采用线性递减超滤率模式有助于减少血透症状性低血压的发生;监测RBV变化有助于预报血透低血压的发生。

Objective To observe the effects of ultrafiitration ( UF ) profiling and measurement of relative blood volume(RBV) as strategies to reduce hemodialysis (HD) -related side effects. Methods 238 dialysis sessions in 68 patients with histories of symptomatic hypotension were followed up from 2001 to 2002 at Xinqiao Hospital Center of Dialysis. Six UF profiles were examined in 238 HD sessions; UF profile 0, with a constant UF rate; UF profile 1, with a linear decreasing UF rate; UF profile 2, with a step-wise decreasing UF rate; and UF profiles 3 through 5, with intermittent high UF rates interrupted by UF pauses. RBV was also measured with a blood volume monitor during HD sessions. Results The incidence of symptomatic hypotension of patients was found to be lower in UFO and UF1 groups than that in UF2 - UF5 groups, and which of UF1 was the lowest in all UF profiles. The occurrences of muscle cramps, vomiting,fatigue, and headache were significantly high during the treatment in UF2 - UF5 groups compared with UFO and UF1 groups ( P <0. 05). RBV values of patients with hypotensive episodes were significantly lower than those of patents with symptomatic episodes during HD treatments ( P < 0. 05 ). Minimal RBV (mRBV) below 88% often was a predictor for occurrence of symptomatic hypotension during HD sessions. Conclusion UF profile with a linear decreasing UF rate may prove to be very helpful in decreasing the occurrence of HD-related symptomatic hypotension. RBV measurement may also help predict the appearance of symptomatic hypotension.