老年肾功能衰竭腹膜透析患者容量控制对血压的影响

Volume control of peritoneal dialysis in elderly patients

目的 探讨限制水钠摄入对老年腹膜透析患者容量负荷及血压的影响。 方法 对我院 38例老年腹膜透析患者实行限制水钠摄入治疗 2个月 ,测定患者治疗前后的体重、容量指标、血压及相关资料。 结果 治疗后有 2 6例患者体重减轻 (2 0± 1 5 )kg ,细胞外液减少 (1 16± 0 86 )L ,收缩压降低 (5 7± 13 7)mmHg ,自我感觉改善 ;另 12例患者体重平均增加 (1 3± 1 2 )kg ,收缩压升高(3 7± 11 3)mmHg。患者治疗前后的收缩压值与标准化的细胞外液 (nECW )均有直线相关关系 (r前=0 379,P <0 0 5 ;r后 =0 393,P <0 0 5 ) ,两者的变量之间也存在直线相关 (r =0 5 14 ,P <0 0 1)。 结论 严格限制老年腹膜透析患者的水钠摄入 ,可以减轻容量负荷 ,降低血压 ,减少降压药物的使用。患者对水钠限制的依从性将影响治疗的效果。

Objective Cardiovascular mortality and morbidity is common in dialysis patients and fluid overload is the most important contributor. The aim of this study was to investigate the relationship between volume overload and hypertension in elderly continuous ambulatory peritoneal dialysis (CAPD) patients and effect of dietary salt restriction on blood pressure control. Methods Thirty-eight CAPD patients with age of 60 years old and over were enrolled in the present study. 38 patients with CAPD were restricted the intake of salt and fluid in stable CAPD patients for two months. Their body weight, extracellular water (ECW), intracellular water (ICW), total body water (TBW), blood pressure, serum albumin levels, urine volume and ultrafiltrate volume were measured before and after the dietary restriction. Bioimpedance analysis was used to assess their fluid status. ECW was normalized by patients' ideal weight (nECW). Results After dietary salt restriction, significant deceases in body weight 〔(60.5±10.3) kg vs (58.5±9.7) kg, P =0.000〕, ECW 〔(15.81±3.03) L vs (14.65±2.61) L, P =0.000〕 and systolic blood pressure 〔(134.0±18.3) mm Hg vs (128.3±21.0) mm Hg, P =0.05〕 were observed in 26 patients whereas the opposite changes were observed in the remaining 12 patients. A significant correlation was found between systolic blood pressure and nECW both before and after two months of dietary restriction ( r _ pre =0.379, P =0.019; r _ post =0.393, P =0.016) and between the changes in systolic blood pressure and changes in nECW ( r =0.514, P =0.001). Conclusions The present study suggests that there is a positive correlation between fluid status and blood pressure. Most of the elderly CAPD patients are fluid overloaded and that dietary salt restriction may be an effective way to control volume and blood pressure. However, the compliance of patients to dietary salt restriction can influence the effect.