中国血液净化

›› 2005, Vol. 4 ›› Issue (7): 354-356.

• 论著 • 上一篇    下一篇

不同钙离子浓度透析液对血液透析患者血压及钙平衡的影响

汤学宇 熊 勇 陈燕芳 崔 晨 吴冬英 谢吉玉   

  1. 421002 衡阳，解放军第169中心医院肾内科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2005-07-12 发布日期:2005-07-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2005-07-12 Published:2005-07-12

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摘要：

目的 研究不同钙离子浓度透析液对维持性血液透析（MHD）患者透析过程中血压及钙平衡的影响，为透析患者选择个体化的钙浓度提供依据。方法 17例血钙正常的稳定的MHD患者分别使用钙离子浓度1.25mmol/L(DCa1.25)、1.50mmol/L(DCa1.5)和1.75mmol/L(DCa1.75)的透析液进行血液透析（透析液其他成分不变），每次透析4h。监测透析前后血压，检测透析前后血清总钙（tCa）、离子钙 iCa）。结果 使用DCa1.25时，透析后血压及tCa、iCa均较透析前明显降低（P＜0.05）。使用DCa1.50时，透析前后血压及tCa、iCa均无明显变化(P＞0.05)。使用DCa1.75时，透析后血压及tCa、iCa均较透析前明显升高( P＜0.01)。结论 对于血压正常、透前血钙正常或轻度低血钙者，DCa1.50的透析液是适用的； 对于MHD中出现明显高血压、高钙血症患者， 应当短期使用 DCa 1.25的透析液；对于MHD中出现明显低血压、低钙血症患者，短期使用DCa1.75的透析液是恰当的。总之，透析液钙浓度不能对所有患者都标准化，应该注重个体化的钙浓度。

关键词: 血液透析, 血压, 总钙, 离子钙

Abstract:

Objective To evalute the acute effects of different calcium concentration dialysate on arterial blood pressure (BP)and calcium balance in maintenance hemodialysis (MHD) patients with normal serum tCa,and to provide scientific basis for individualized calcium concentration dialysate formula. Methods Dialysate with different calcium concentration (1.25mmol/L、1.5mmol/L、1.75mmol/L) as DCa1.25, DCa1.5 and DCa1.75 was used in seventeen stable MHD patients.Arterial blood pressure was measured before and after each dialysis session,and every 30 minutes during hemodialysis session. Serum total calcium and ionized calcium was assessed before and after each dialysis session with different calcium concentration dialysate.Results With the DCa1.25,BP,serum tCa and iCa decreased as compared with pre-dialysis values (P ＜0.05).With the DCa1.5, no signifiCant changes of BP,serum tCa and iCa between pre-dialysis and post-dialysis was found. With the DCa1.75,BP,serum tCa and iCa increased signifiCantly as compared with pre-dialysis values (P＜0.01). Conclusions DCa 1.5 can be used in MHD patients with normol BP and normol serum tCa or slight hypocalcemia. DCa1.25 can be used shortly in MHD patients with hypertension and hypercalcemia. DCa1.75 is suitable for MHD patients with hypotension and hypocalcemia. In a word,calcium concentration in dialysate can not be on the same level in all MHD patients, more attention should pay to individualized clciunconlen tration dialysate formula.

Key words: Blood pressure, Total calcium, Ionized calcium

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