构建动态体位辅助透析模型及稳定透析后期血流动力学的研究  

Construction of a dynamic position-assisted dialysis model and study of hemodynamics in later stage of stable dialysis

作　　者：敖华 敖宁佳 王路遥 叶琤 吴雪兵 窦军 李明 AO Hua;AO Ning-jia;WANG Lu-yao;YE Cheng;WU Xue-bing;DOU Jun;LI Ming(Sinopharm Gezhouba Central Hospital,Third Clinical Medical College of China Three Gorges University,Yichang 443002,Hubei,China;School of Life Sciences,Hubei University,Wuhan 430062,Hubei,China;Research Center of Fluid Machinery Engineering and Technology,Jiangsu University,Zhenjiang 212013,Jiangsu,China)

机构地区：[1]国药葛洲坝中心医院,三峡大学第三临床医学院,湖北宜昌443002 [2]湖北大学生命科学学院,湖北武汉430062 [3]江苏大学流体机械工程技术研究中心,江苏镇江212013

出　　处：《生物医学工程与临床》2025年第2期233-239,共7页Biomedical Engineering and Clinical Medicine

摘　　要：目的探讨构建多情景“动态体位辅助透析模型”,并探讨模型对稳定透析回血前后时期血流动力学的效果。方法选择2021年6月至2022年4月在国药葛洲坝中心医院肾内科治疗的维持血液透析(MHD)患者156例,其中男性77例,女性79例;年龄18~77岁,平均年龄54.65岁;透析龄19~76个月,平均透析龄41.17个月;高血压95例,糖尿病90例,高尿酸血症85例,其他肾脏疾病15例;身体质量指数(BMI)17.8~26.9 kg/m^(2),平均BMI 23.43 kg/m^(2);血尿素(BUN)8.9~35.9 mmol/L,平均BUN 17.94 mmol/L;血红蛋白(Hb)99~126 g/L,平均Hb 109.16 g/L;白蛋白(Alb)30~41 g/L,平均Alb 35.12 g/L。随机分为观察组(n=78)和对照组(n=78)。选择Fresenius 4008S透析仪在线相对血容量(RBV)曲线功能,观察组在RBV变化(ΔBV)曲线下降变陡时,予“抬腿位”并保持,若RBV曲线回升则继续超滤300~450 mL后结束超滤,与回血同步由“抬腿位”渐变为“斜靠位”;对照组达到预定超滤量则结束超滤,或发生透析相关低血压(IDH)则停止超滤,若IDH未缓解,予回输100~200 mL液体观察30 min后再尝试超滤,回血时采用“平卧位”。观察组与对照组回血操作均按日常泵速及流量100 mL/min,约5 min回输完毕,收集透析0 h、结束超滤时、回血结束时生物电阻法测定每搏量(SV)、每搏量变异度(SVV)、心输出量(CO)、透析前心脏指数(CI)、心率(HR)、收缩压(SBP)、舒张压(DBP)、平均超滤量等参数。结果超滤结束时观察组SBP、CI、CO、SV及超滤量均高于对照组[(121.62±8.34)mmHg vs(109.24±7.96)mmHg、(3.14±0.28)L/(min·m^(2))vs(2.89±0.21)L/(min·m^(2))、(4.32±0.32)L/min vs(4.21±0.28)L/min、(11.45±0.66)mL/B vs(10.06±0.70)mL/B、(2.98±0.54)L vs(2.52±0.48)L。P<0.05],观察组SVV低于对照组[(5.47±0.33)%vs(6.41±0.47)%。P<0.05];两组HR比较,差异无统计学意义(P>0.05);透析回血后观察组SBP、HR、CI、CO、SV均低于对照组[(126.24±9.23)mmHg vs(138.42±8.34)mmHg、(85.37±7.08)次/分vs(94Objective To establish multi-scenario“dynamic position-assisted dialysis model”,and explore the model effect on hemodynamics before and after stable dialysis blood returning.Methods From June 2021 to April 2022,a total of 156 patients with maintaining hemodialysis(MHD)were enrolled,which included 77 males and 79 females,aged 18-77 years old with mean age of 54.65 years old;dialysis was 19-76 months with mean time of 41.17 months;95 cases of hypertension,90 of diabetes mellitus,85 of hyperuricemia and 15 of other kidney diseases;body mass index(BMI)was 17.8-26.9 kg/m^(2) with mean BMI of 23.43 kg/m^(2);blood urea nitrogen(BUN)was 8.9-35.9 mmol/L with mean BUN of 17.94 mmol/L;hemoglobin(Hb)was 99-126 g/L with mean Hb of 109.16 g/L;albumin(Alb)was 30-41 g/L with mean Alb of 35.12 g/L.All of them were randomly divided into observation group(n=78)and control group(n=78).The online relative blood volume(RBV)curve function of Fresenius 4008S dialyzer was selected.In observation group,the RBV change(ΔBV)curve was decreased and steepened,the“leg-raising position”was given and maintained;RBV curve was rebounded,the ultrafiltration was completed after ultrafiltration of 300-450 mL,which was synchronized with blood returning,and the“leg-raising position”was gradually changed to“tile position”.In control group,ultrafiltration was terminated when the predetermined ultrafiltration volume was reached,ultrafiltration was stopped when intradialytic hypotension(IDH)occurred;IDH was unrelieved,100-200 mL of liquid was reinfused for 30-minute before ultrafiltration,and“supine position”was used for blood return.The blood return operation of observation group and control group was completed according to the daily pumping rate and flow rate of 100 mL/min,and reinfusion was completed about 5-minute.The stroke volume(SV),stroke volume variation(SVV),cardiac output(CO),cardiac index(CI),heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),and mean ultrafiltration volume were measured by bioelectric

关 键 词：动态体位 血流动力学 容量负荷 透析回血 

分 类 号：R318.6[医药卫生—生物医学工程] R459.5[医药卫生—基础医学] R45