中心静脉压监测在血液净化中的应用

Application of inspecting central venous pressure in blood purification

目的 研究中心静脉压 (CVP)的监测在血液净化治疗中的作用以及对超滤量的指导意义。方法 从本中心自 1996年至 2 0 0 3年行中心静脉压监测的血液净化患者中选出 2 2人 ,定为A组 ,回顾性的观察其在中心静脉压监测指导下血液净化中的超滤量、血压、心率和血液净化间期血压、心功能的状态及身体状况。选取同期未行中心静脉压监测的身体和病情相似的患者 31人 ,为B组。A组和B组分别在血液净化中低血压的发生率、血液净化间期心力衰竭的发生率、APACHEⅢ评分方面进行比较 ,同时A组在血液净化中的超滤量与临床估算超滤量进行比较 ,分析有无差异性。结果 A组与B组相比 ,在血液净化中低血压的发生率、血液净化间期心力衰竭的发生率、APACHEⅢ评分方面均有显著性差异 (P <0 .0 5 )。A组的超滤量和临床估算的超滤量比较亦有显著性差异 (P <0 .0 5 )。结论 中心静脉压监测便于观察血液净化患者循环血量的动态变化 ,对于及时、准确的调整超滤量有指导意义 ,并对危重患者心功能的改善和预后有积极作用。

Objects To study the application of monitoring central veneus pressure in the blood purification and it's significance for ultrafiltration volume.Methods Twenty-two maintenance hemodialysis patients who received CVP monitoring from 1996 to 2003 in our dialysis center were selected as group A. Their ultrafiltration volume, blood pressure(BP) amd heart rate(HR) during dialysis and their Bp, heart function and body condition during the interm of dialysis were observed. Thirty-one dialysis patients who did not receive CVP monitortry and had same general condition were selected as group B. The incidence of hypotension during hemodialysis, heart failure during the intermission of hemodialysis and the score of APACHE III were compared between the two groups. The ultrafiltration volume during blood purification and the dehydration volume estimated clinical signs of group A were compared. Results There were significant difference between the two groups of the incidence of hypotention during hemodialyis, heart failune during the intermission of blood purification and score of APACHE III (P<0.005). There were also significant difference of ultrafiltration volume during bolld purification and the delydration volume estimated by clinical signs of group A (P<0.005).Conclusions CVP monitoring is helpful for hemodialysis patients to observing the ambulatory changing of circulating blood volume. It has a guiding significance to adjust ultrafiltration volume on time and auurately and to improve heart function and prognosis for those severe patients.