不同缓冲剂碳酸盐透析液对维持性血液透析患者血压及血钙的影响  

Influence of different bicarbonate in dialysate on calcium balance and blood pressure in hemodialysis patients

作　　者：韩雪[1,2] 丁嘉祥[1,2] 郭王[1,2] 刘静[1,2] 刘文虎[1,2] 

机构地区：[1]首都医科大学附属北京友谊医院肾内科,北京100050 [2]首都医科大学肾病学系

出　　处：《中国血液净化》2014年第8期573-576,共4页Chinese Journal of Blood Purification

基　　金：北京市科学技术委员会课题(D131100004713001);十二五科技支撑计划(2011BAI 10B00)

摘　　要：目的比较枸橼酸碳酸氢盐透析液和醋酸碳酸氢盐透析液对维持性血液透析患者血压及血钙的影响,为临床选用最佳透析液提供理论依据。方法 16例透析患者进行自身前后对照研究,前3周使用枸橼酸透析液,透析液钙浓度依次是1.75mmol/L(DCa1.75)、1.5mmol/L(DCa1.5)和1.25mmol/L(DCa1.25)。后3周使用醋酸透析液,依次是DCa1.75、DCa1.5、DCa1.25。比较使用不同透析液透析前后患者血清总钙(tCa)、离子钙(iCa)及平均动脉压(MAP)的变化。结果 1DCa1.75时,2种透析液均使患者透析后tCa、iCa升高,对透析后MAP无影响。2DCa1.5时,醋酸透析液使透析后tCa、iCa升高,枸橼酸透析液对透析后tCa、iCa无影响,二者对透析后MAP无影响。3DCa1.25时,枸橼酸透析液使透析后tCa、iCa降低,MAP由(97±16)mmHg降至(86±21)mmHg(P<0.05)。使用醋酸透析液患者透析后tCa降低,而iCa、MAP无变化。结论 DCa1.5的枸橼酸透析液对透析患者血清tCa、iCa水平及MAP影响最小。Objective To evaluate the effects of different calcium concentration in citrate bicarbonate versus acetate bicarbonate buffered dialysate in maintenance hemodialysis （MHD） patients.Methods Sixteen stable MHD patients were treated with the citrate bicarbonate buffered dialysate containing Ca＋2 1.75 mmol/L （DCa 1.75）,1.5 mmol/L （DCa 1.5） and 1.25 mmol/L （DCa 1.25） each for one week for 3 weeks,and then with the acetate bicarbonate buffered dialysate containing Ca＋2 1.75 mmol/L （DCa 1.75）,1.5 mmol/L （DCa 1.5） and 1.25 mmol/L （DCa 1.25） each for one week for another period of 3 weeks.Serum total Ca （tCa）,ionized Ca （iCa） and mean arterial pressure （MAP） were measured before and after the hemedialysis using each kind of dialysate.Results ① tCa and iCa increased and MAP unchanged in patients using either citrate bicarbonate or acetate bicarbonate buffered dialysate with DCa 1.75.② tCa and iCa increased in patients using acetate bicarbonate buffered dialysate with DCa 1.5,but unchanged in those using citrate bicarbonate buffered dialysate with DCa 1.5.MAP unchanged using either citrate bicarbonate or acetate bicarbonate buffered dialysate with DCa 1.5.③ tCa and iCa decreased and MAP lowered from 97±16 to 86±21 mmHg （P＜0.05） in patients using citrate bicarbonate buffered dialysate with DCa 1.25,and 25％ of these patients experienced perspiration,muscle cramps and discomfort.tCA decreased and iCa and MAP unchanged in those using acetate bicarbonate buffered dialysate with DCa 1.25.Conclusion tCa,iCa and MAP were relatively stable in MHD patients using citrate bicarbonate buffered dialysate containing 1.5 mmol/L calcium.

关 键 词：枸橼酸 碳酸氢盐 透析液 钙 血压 血液透析 

分 类 号：R318.16[医药卫生—生物医学工程]