个体化低温透析对预防血液透析中低血压及肌肉痉挛的作用  

The role of individualized low temperature dialysis in prevention of imradialytic hypotension and muscle spasms

作　　者：龚丽娜[1] 

机构地区：[1]佛山市南海区第二人民医院肾内科,528251

出　　处：《国际医药卫生导报》2013年第18期2873-2876,共4页International Medicine and Health Guidance News

摘　　要：目的探讨个体化低温透析预防血液透析中低血压及肌肉痉挛的作用。方法选择在本院维持性血液透析中易发生低血压和／或肌肉痉挛的患者22例，透析温度分别设定为常温（37℃）、低温（35℃）和个体化低温（由上机实测体温调低0．5℃）各治疗4周，共计12周。所有患者每次透析监测血压、心率及记录肌肉痉挛发生次数，记录畏寒、寒颤等不耐受情况。每周监测透析前后生化指标。结果1）不同透析温度下，患者血红蛋白、电解质、血浆白蛋白、C反应蛋白、肌钙蛋白T、甲状旁腺素、尿素清除指数比较差异无统计学意义。2）个体化低温透析血压明显高于常温透析[收缩压（146±18）mmHgvs（138±19）mmHg，舒张压（77±7）mmHgvs（68±7）mmHg，平均动脉压（103±7）mmHgvs（95±11）mmHg，P〈0．051，心率、低血压发生率、肌肉痉挛发生率均明显低于常温透析[（78±7）次／minvs（85±7）次，min，23．1％vs30．9％，25．0％vs32．7％，P〈0．05），与低温透析时比较差异无统计学意义。3）个体化低温透析畏寒、寒颤等不耐受现象发生率明显低于低温透析（8．2％vs11．8％，P〈0．05）。结论个体化低温透析能降低透析中低血压及肌肉痉挛的发生率，同时避免了低温透析带来的寒冷不适，提高了患者对血液透析的耐受性。Objective To explore the role of individualized low temperature dialysis in prevention of intradialytic hypotension and muscle spasms. Methods Selected 22 patients prone to hypotension and/or muscle spasms in the maintenance hemodialysis, dialysis temperature set at room temperature （ 37 ℃ ） , low temperature （ 35 ℃ ） and individualized low temperature （the measured temperature reduced by 0.5 ℃ ）, 4 weeks of treatment for each and a total of 12 weeks. To monitor blood pressure, heart rate of all patients in every dialysis, and recorded the numbers of muscle spasms, the chills intolerance. We monitored the biochemical markers weekly before and after dialysis. Results （1） At each dialysis temperature, patients＇ hemoglobin, electrolytes, serum albumin, C-reactiveprotein, troponin T, parathyroid hormone, urea clearance index had no significant difference. （2） Blood pressure was significantly higher, heart rate, incidence of hypotension and muscle spasms were significantly lower than normal temperature dialysis in individualized low temperature dialysis（P 〈 0.05）, no significant difference found with low temperature dialysis. （3） The chills intolerances in individualized low temperature dialysis were lower than those of the low temperature dialysis. Conclusion Individualized low temperature dialysis can reduce the occurrence of hypotension and muscle spasms, avoiding the cold discomfort in low temperature dialysis, and can increase tolerability of patients on hemodialysis.

关 键 词：低温透析 透析中低血压 肌肉痉挛 预防作用 

分 类 号：R459.5[医药卫生—治疗学]