中国血液净化

›› 2005, Vol. 4 ›› Issue (8): 443-446.

• 论著 • 上一篇    下一篇

可调性透析液温度与盐浓度对血液透析过程中低血压发生的干预评价

赵学伟 周伟 张智敏 张五星 李 洋 周焕芝 程圣英 程雪梅   

  1. 100091 北京，中国人民解放军总医院第二附属医院肾内科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2005-08-12 发布日期:2005-08-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2005-08-12 Published:2005-08-12

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摘要： 目的 探讨透析液的温度与盐浓度对血液透析过程中低血压的干预策略及临床疗效。方法 选择在中国人民解放军总医院第二附属医院常规接受血液透析时间超过6月，有超过3/4透析次数中发生症状性低血压，同时收缩压下降至少25%和(或)收缩压低于100mmHg(1mmHg = 0.133Kpa)，需要药物干预的门诊患者4例。每个患者分别接受低温高盐透析、低温标准透析、常温高盐透析、常温标准透析各3次，监测患者的平均动脉压MAP，数据用Microsoft Excel登记汇总，用SSPS软件进行齐次性检验和方差分析，以 P＜0.05为差异有显著性意义。结果 四组病例透析中、透析后的MAP进行方差分析，各组在P ＜0.05水平上差异有显著性。采用LSD法对透析中各组MAP进行均值多重比较，常温标准透析在P＜0.05水平上与其他3组差异有显著性；采用Tamhane法对透析后各组MAP进行均值多重比较，低温高盐透析在P＜0.05水平上与常温高盐透析和常温标准透析差异有显著性。结论 低温高盐透析改善患者对超滤的耐受性，有益于避免IDH，显著减少了护理措施和医疗成本。患者对低温高盐透析感知正面积极，是一种简单、有益和经济的措施。

关键词: 低血压, 血液透析

Abstract:

Objective To explore the strategies of using adjustable Objective To explore the strategies of using adjustable dialysate temperature and sodium concentration to reduce the occurrence of intradialytic hypotension and observe its clinical effects. Methods Four out-patients in our unit who had received haemodialysis for more than 6 months shown symptomatic hypotension in more than 3/4 episodes of treatment, with a than 25% reduction and /or lower than 100mmHg of systolic blood pressure needing medication were selected to participate this experiment. Each patient underwent cool-temp and high-sodium, cool-temp and standard-sodium, standard -temp and high-sodium, standard-temp and standard-sodium dialysis for 3 times respectively, and MAP were monitored during the process. Microsoft Excel was used to enroll and collect the data, SPSS software was used to do Test of Homogeneity of Variance and One-Way ANOVA, and statistical significance was defined as P＜0.05. Results One-Way ANOVA of the MAP data during and after haemodialysis in the 4 cases showed that there were significant differences at the level of P＜0.05 in each group. Post Hoc Multiple Comparisons of the MAP during haemodialysis in each group using LSD method showed that there were significant differences at the level of P＜0.05 between standard-temp and standard-sodium dialysis group and other three groups. Post Hoc Multiple Comparisons of the MAP during haemodialysis in each group using Tamhane method showed that there were significant differences at the level of P＜0.05 between cool-temp and high-sodium dialysis group and standard-temp and high-sodium, standard-temp and standard-sodium dialysis group. Conclusion cool-Temp and high-sodium dialysis improves tolerance for dialysis in hypotensive patients and helps increase ultrafiltration while maintaining haemodynamic stability during and after dialysis. Patients?perceptions were positive. The use of cool dialysate is a simple, useful and economical procedure, especially for highly symptomatic patients.

Key words: Haemodialysis

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