低温透析与可变钠透析对血透相关性低血压的作用  

Effect of hypothermia hemodialysis and natrium-controlled hemodialysis on hemodialysis-related hypotension

作　　者：李正[1] 陈民[1] 

机构地区：[1]成都市第一人民医院肾内科,四川成都610016

出　　处：《西部医学》2006年第2期147-149,共3页Medical Journal of West China

摘　　要：目的探讨透析液钠浓度、透析液温度对透析相关性低血压的影响。方法规律血透患者中经常发生透析中低血压的5例患者,均经标准透析、可变钠透析、低温透析和可变钠+低温透析,观察各组患者体重、超滤量、体温、Scr、BUN,并计算BUN下降率(URR)、血钠;透析中动态观察病人的血压,并计算平均动脉压(M AP),记录患者透析中的不良反应。结果透析后体重、超滤量、URR、血钠在4种透析模式间均无明显差异;低温组、可变钠+低温透析组透析后体温降低;可变钠透析、低温透析、可变钠+低温透析组均较标准透析组M AP有所提高(P<0.05),以可变钠+低温透析组提高最明显;可变钠、低温、可变钠+低温透析组低血压发生次数较标准组减少,以可变钠+低温组减少最明显;可变纳、低温透析、可变钠+低温透析组均较标准透析组不良反应低(P<0.05),以可变钠+低温透析组不良反应最低。结论标准透析、可变钠透析、低温透析和可变钠+低温透析模式在透析效率方面没有差别;但可变钠、低温和可变钠+低温透析模式M AP较标准透析模式提高,而低血压及不良反应较低,尤以可变钠+低温透析组明显。Objective To find out whether or not natrium concentration and dialysate temperature are the impacting factors for hemodialysis-related hypotension. Methods The study included five patients in whom hypotension always occurred in the course of hemodialysis. They were all treated in order by （1） standard dialysis, （2） alterable natrium-concentration dialysls, （3） hypothermia hemodialysis, and （4） alterable natrium concentration＋ hypothermia dialysis. We measured the body weight, uhrafihration volume, temperature, Scr, BUN, URR, blood serum natrium, blood pressure as well as mean arterial pressure. Results The body weight, uitrafilteration volume, URR, serum natrium had no statistical difference after dialysis among the four dialysis patterns. The body temperature decreased in hypothermia dialysis group and alterable natrium ＋ hypothermia dialysis group. Mean arterial pressure was higher in patients with alterable natrium dialysis, hypothermia hemodialysis, and alterable natrium＋hypothermia dialysis than those with standard dialysis （P≤0. 05）. The frequency of hypotension was lower in the three groups than standard dialysis group and so was the incidence of adverse reaction （P≤0. 05）. Conclusion There is no obvious difference regarding the efficiency among the four dialysis regimes. However, the alterable natrium dialysis, hypothermia hemodialysis and alterable natrium dialysis ＋ hypothermia dialysis enable to maintain a relatively stable mean arterial pressure and the hypotension and adverse reaction are milder than standard dialysis, in which alterable natrium dialysis ＋ hypothermia dialysis is especially favorable.

关 键 词：标准透析 低温透析 可变钠透析 可变钠+低温透析 低血压 

分 类 号：R695.2[医药卫生—泌尿科学] R459.6[医药卫生—外科学]