钠与超滤模式对血液透析中低血压的作用

Impact of sodium and ultrafiltration profiling on hemodialysis related hypotension

目的比较线性钠模式(SP)、线性超滤模式(UP)、线性钠和线性超滤结合模式(SP+UP)与标准透析(SD)在透析过程中症状性低血压的发生情况。方法12例稳定血透患者,SD、SP、UP、SP+UP各进行10次,监测透析过程中相对血容量(RBV)、平均动脉压(MAP)、心率(HR)、下腔静脉宽度(IVCD)、心排血量(CO)、每搏输出量(SV)、血钠、血浆渗透浓度的变化及发生症状性低血压的例次。结果(1)4种模式透前IVCD、MAP、HR、体重、透析过程中钠清除量、超滤量无明显差异。(2)SP+UP发生症状性低血压的例次显著低于其他3种模式。(3)SP+UP在透析4、5h时RBV值高于SD、SP、UP(P<0.01)。(4)SD、SP、UP透析4h时MAP明显低于SP+UP(P<0.05);透析5h时HR明显高于SP+UP(P<0.01)。(5)UP在透析3h时SV低于其他3种模式(P<0.05),CO较透前降低(P<0.05)。(6)透析1h时SP及SP+UP的血钠、血浆渗透浓度明显高于SD、UP。结论在钠清除量大致相等情况下,SP+UP比SD、SP、UP具有较好维持血容量作用,可显著减少症状性低血压的发生。

Objective To evaluate the efficacy of sodium profiling(SP), ultrafiltration profiling(UP) and combination of the two techniques(SP+UP) to reduce intradialytic hypotension. Methods Twelve stable hemodialysis patients underwent standard dialysis(SD), SP, UP, SP+UP for 10 times respectively. Relative blood volume(RBV), mean arteial blood pressure(MAP), heart rate(HR), interior vena cava diameter(IVCD), cardiac output(CO), stroke volume(SV), serum sodium, serum osmolarity were measured hourly during dialysis session. The frequency of symptomatic hypotension was also recorded. Results The IVCD, MAP, HR, weight of predialysis and sodium balance, ultrafiltration during dialysis were similar among the four profiles. Compared with SD, SP, UP, the frequency of hypotension in SP+UP was significantly reduced, SP+UP improved blood pressure and blood volume preservation. The SV at 3h was significantly decreased in UP compared with that in SD,SP,SP+UP(P< 0 05). The serum sodium and serum osmolarity at 1h in SP and SP+UP were higher than those in UP and SD(P< 0 05). Conclusion As the similar intradialysis sodium balance among the four profiles, blood volume is better preserved and hypotensive episodes significantly decrease in SP+UP.