中国血液净化

中国血液净化 ›› 2015, Vol. 14 ›› Issue (06): 328-331.doi: 10.3969/j.issn.1671-4091.2015.06.003

• 临床研究 • 上一篇    下一篇

不同血液净化方式对维持性血液透析患者眼压的影响

张燕京1,毛永辉1,赵晶2,王铮2,戴虹2   

  1. 1 卫生部北京医院肾脏内科
    2. 北京医院眼科
  • 收稿日期:2015-01-29 修回日期:2015-04-14 出版日期:2015-06-12 发布日期:2015-05-29
  • 通讯作者: 毛永辉 mmdn2009@163.com E-mail:mmdn2009@163.com
  • 基金资助:

    国际多中心研究(BJ-2012-43)

The influence of different blood purification methods on intraocular pressure in maintenance hemodialysis patients

  • Received:2015-01-29 Revised:2015-04-14 Online:2015-06-12 Published:2015-05-29
  • Contact: Yong-hui MAO E-mail:mmdn2009@163.com

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摘要： 【摘要】目的了解维持性血液透析患者在透析过程中眼压的变化规律，并比较血液透析(HD)及血液滤过(HF)2 种不同血液净化方式对眼压的影响。方法选择我院维持性血液透析患者共78 例，分为血液透析组(n=63)和血滤过组(n=15)。记录所有患者治疗前后的收缩压及舒张压，计算平均动脉压。记录脱水量。测定所有患者治疗前后及治疗2h 的卧位眼压及治疗前后血渗透压、血红蛋白、红细胞压积、血肌酐、血尿素氮、血糖、血钠的水平。采用t 检验及Pearson 相关分析进行统计学处理。结果与治疗前相比，两组患者治疗后收缩压及平均动脉压均明显下降。2 组患者治疗过程中眼压变化均是先上升后下降，治疗后眼压低于治疗前水平。血液透析组治疗后眼压明显低于治疗中(P＜0.01)，而血液滤过组变化无统计学差异。2 组间各理化指标的变化率比较仅Scr 与BUN 有明显统计学差异(P＜0.01)，血液滤过组低于血液透析组，余均无明显差异。双眼压的下降率与脱水量之间呈明显正相关关系(r 分别为0.305、0.343，均P＜0.05)。结论2 种治疗方式治疗过程中眼压的变化均是先升高后下降，治疗结束后眼压低于治疗前水平，血液透析治疗中眼压升高的更明显，而血液滤过治疗中眼压变化更稳定，提示血液滤过治疗血流动力学更稳定，对眼压的影响也较小。

关键词: 血液透析, 血液滤过, 眼压

Abstract: 【Abstract】Objective To observe the change pattern of intraocular pressure and the effect of hemodialysis and hemofiltration on intraocular pressure in maintenance hemodialysis (MHD) patients. Methods A total of 78 MHD patients treated in Beijing Hospital were divided into hemodialysis group (n=63) and hemofiltration group (n=15). Systolic and diastolic blood pressure and the derived average artery pressure were measured before and after dialysis. The dehydration volume after dialysis was calculated. Intraocular pressure at supine position was recorded before dialysis, after the initiation of dialysis for 2 hours, and after dialysis. Osmotic pressure, hemoglobin, hematocrit, serum creatinine (Scr), blood urea nitrogen (BUN), blood glucose and sodium were assayed before and after dialysis. t-test and Pearson correlation analysis were used for statistical analyses. Results Systolic blood pressure and average artery pressure decreased remarkably after dialysis in both groups. Intraocular pressure increased at the beginning of dialysis then decreased afterwards to a level lower than that before dialysis in both groups. Intraocular pressure after the treatment was significantly lower than that during dialysis in hemodialysis group (P＜0.01), but was unchanged in hemofiltration group. Changes of Scr and BUN after dialysis were significantly higher in hemodialysis group than in hemofiltration group (P＜0.01), but changes of other blood biochemistry parameters were similar between the two groups. The decrease of intraocular pressure in right and left eyes was positively correlated with the dehydration volume after dialysis (r=0.305 and 0.343, respectively; P＜0.05). Conclusions Intraocular pressure increased at the beginning of dialysis then decreased afterwards in both groups. Intraocular pressure at the end of dialysis was lower than that before dialysis. Intraocular pressure during dialysis increased more in hemodialysis group and stabilized significantly in hemofiltration group, suggesting that hemofiltration resulted in less hemodynamics disturbances and thus less intraocular pressure changes.

Key words: Hemodialysis, Hemofiltration, Intraocular pressure