中国血液净化

›› 2008, Vol. 7 ›› Issue (4): 175-178.

• 论著 •    下一篇

在线血容量监测在血液透析中的临床应用

徐太静 郑美芬 江薇   

  1. 同济大学附属东方医院肾内科 同济大学附属东方医院肾内科 同济大学附属东方医院肾内科
  • 收稿日期:2008-01-15 修回日期:1900-01-01 出版日期:2008-04-12 发布日期:2008-04-12
  • 通讯作者: 徐太静

  • Received:2008-01-15 Revised:1900-01-01 Online:2008-04-12 Published:2008-04-12

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摘要： 目的 通过在线血容量(Blood volume，BV)监测血透过程中相对血容量(Relative blood volume，RBV)变化，探讨其在血液透析（Hemodialysis，HD）相关低血压及高血压中的作用。方法 选择31例维持性HD患者,根据血压情况将患者分为正常血压（Normal blood pressure，NBP）组10例、症状性低血压（Dialysis-SymPtomatic hyPotension，SH）组12例，难治性高血压（Dialysis-refractoy hypertension，RH）组10例，应用在线BV监测法观察HD中RBV、血压、超滤量（Ultrafiltration volume，UV）、平均动脉压（Mean arterial pressure，MAP）的变化。研究分三阶段进行，第一二阶段为观察期，第三阶段为干预调整期，并比较分析各阶段、各组患者各项指标的变化规律。 结果 NBP、SH、RH各组RBV变化均存在显著性差异（P<0.05），对SH组进行上调干体重或改变超滤方式，SH发生率明显下降（P<0.05）；对RH组患者加强超滤，其MAP较前显著下降（P<0.05）。 结论 不同HD患者RBV的变化存在差异，监测HD中RBV变化可以对HD患者的干体重合理设定提供重要信息，进而制定相应的个体化透析方案，能有效减少SH发生、控制RH，提高透析安全性,，值得临床推广。

关键词: 血液透析, 血容量, 低血压, 干体重

Abstract: Objective To investigate the role of on-line blood volume monitoring on prevention of dialysis-Symptomatic hypotension and dialysis-refractoy hypertension during hemodialysis. Methods 31 cases of hemodialysis patients were divided into three groups according to their blood pressure: normal blood pressure (NBP) group (n = 9), symptomatic hypotension (SH) group (n = 12), refractory hypertension (RH) group (n = 10), and observed the relative blood volume(RBV), blood pressure (BP), ultrafiltration volume (UV), mean arterial pressure (MAP)by on-line blood volume monitoring. The Research carried out in three stages, stage 1 and stage 2 for the observation period, the third stage for the intervention period, then comparatively analysis of the changes of the indicators. Results The RBV changes in NBP, SH, RH groups were significant different (P <0.05); by increasing dry weight or changing ultrafiltration mode of SH group, the incidence of SH was significantly decreased (P<0.05), by enhancing ultrafiltration of RH group,the MAP before or aftre hemodialysis was significantly decreased (P <0.05). Conclusions The RBV changes are different in HD patients with different blood pressure, on-line blood volume monitoring could provide important information for the set of dry weight,do good to formulated individual dialysis programmes , and effectively reduce the occurrence of dialysis-SymPtomatic hyPotension, low down the MAP of dialysis-refractoy hypertension patients,then improve the dialysis security. on-line blood volume monitoring was worthy of clinical promotion.