血液透析时在线血容量监测对血压控制影响的研究  

The Effect of On-line Blood Volume Monitor on The Control of Blood Pressure during Hemodialysis

作　　者：陈利明[1] 邹建洲[1] 刘中华[1] 方艺[1] 王一梅[1] 丁小强[1] 

机构地区：[1]复旦大学附属中山医院肾内科,上海200032

出　　处：《中国临床医学》2008年第6期836-839,共4页Chinese Journal of Clinical Medicine

基　　金：上海市科学技术委员会重大科技攻关计划(08DZ1900602)

摘　　要：目的:通过在线血容量监测了解透析过程中的血容量变化透析中防治低血压和控制高血压,调整透析患者干体重,减少透析并发症。方法:100例规律性血透患者,平均透析时间58.67±31.54个月,根据临床表现分为正常血压(A)组、症状性低血压(B)组和难治性高血压(C)组。通过血容量监测仪测定患者血透时的RBV、△RBV/Δt、Hb、Hct、BWC的变化,观察透析过程中患者心率、呼吸、血压、超滤量和超滤率的变化,比较3组各项指标的变化并分析各参数间的关系。结果:治疗过程中随超滤脱水量增加,超滤脱水率逐渐下降。3组中B组超滤量最大,超滤率最高,RBV、△RBV的下降也最明显。同时伴SBP、DBP、MAP下降,且明显低于A组(P<0.05)。随血容量下降,血压明显下降,△RBV和血压两者之间呈显著正相关(r=0.846,P=0.001)。C组超滤脱水量最小,超滤脱水率最低,RBV、△RBV的下降也最小。同时伴有血压升高,与另2组相比有统计学意义(P<0.001)。随血容量下降,而血压逐渐升高,两者之间呈现负相关(r=(0.911,P=0.004)。对5例低血压和7例高血压患者在血容量监测的指导下分别上调或下调干体重后,血压得到有效控制。结论:在线血容量监测有助于确定合适的超滤量,调整干体重,从而达到个体化的容量和血压的理想控制。Objective：To evaluate the effect of on-line blood volume monitor （BVM） on the changes of blood volume during hemodialysis, to prevent symptomatic hypotension and dialysis refractory hypertension. Methods： 100 patients on maintenance hemodialysis were enrolled, with dialysis periods of 58.67 ± 31.54 months. The patients were divided into 3 groups according to the clinical manifestations, normal blood pressure group（n = 34）, symptomatic hypotension group （n = 22）, and refractory hypertension group （n = 44） . Using BVM to measure the changes of RBV,△RBV/△t, Hb, Hct,BWC and to observe the influence on heart rate,respiration, blood pressure, ultrafihration volume and ultrafihration rate. Results： With the increasing fluid removed by hemodialysis ultrafiltration, the uhrafihration rate gradually decreased. In symptomatic hypotension group, the high est uhrafiltration volume and uhrafiltration rate were observed, with the most significant decrease of RBV and △RBV . The decrease of SBP,DBP,MAP in symptomatic hypotension group are significantly lower than that in normal blood pressure group （P〈0.05）. A significant positive correlation was observed between △RBV and MAP （r= 0. 846, P = 0. 001 ）. In the refractory hypertension group, the lowest ultrafihration volume, ultrafiltration rate and the decrease in both RBV △RBV were observed. In refractory hypertension group, the blood pressure had a negative correlation with the blood volume, the gradually increase in the blood pressure was significant when the blood volume decreased （r= （0.911, P = 0. 004）. After up-regulation and down-regulation of the dry body weight, 5 patients with hypotension and 7 patients with hypertension experienced effective blood pressure control respectively. Conclusion：On-line blood volume monitor provides instrumentation to confirm patients＇ ultrafiltratrion volume and regulation of dry body weight,which leads to an optimal and individualized volume and blood pressure control.

关 键 词：血液透析 血容量监测 超滤 相对血容量 血压 

分 类 号：R459.5[医药卫生—治疗学]