›› 2003, Vol. 2 ›› Issue (6): 301-304.

• 论著 • 上一篇    下一篇

低温透析对改善患者透析过程低血压发生的观察

林爱武 严玉澄 钱家麒   

  1. 200001 上海,上海第二医科大学附属仁济医院肾内科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2003-06-19 发布日期:2003-06-19

  • Received:1900-01-01 Revised:1900-01-01 Online:2003-06-19 Published:2003-06-19

摘要: 目的 本研究探讨低温透析液对降低患者透析过程中低血压发生的作用。方法 按照标准选 取我院规律性血液透析过程中易于发生症状性低血压( SH)的15名患者。采用自身交叉对照的方法,分别进行8~10次的常温透析(37℃)和低温透析(35.5℃),观察透析前和透析开始后每小时的动脉血路的温度(反映患者体温)、相对血容量(RBV)、血压、心率、超滤量和低血压的发生情况,比较两组的差异。结果 共进行常温透析149次和低温透析151次。随着透析的进行,两组的RBV逐渐下降,出现低血压时的RBV分别为78%(低温组)和80%(常温组)。与常温组比较低温组症状性低血压发生率明显低(25.2%,39.6%,P= 0.002),发生低血压的时间明显晚(3.93±0.49)小时,(3.66±0.73)小时,(P=0.038),低血压发生时的超滤量明显多(3500.21±843.10,3157.28±729.50,P=0.035)。RBV和心率两组无差异。但二组患者透析过程中的体温均逐渐升高,常温组始终明显高于低温组。 结论 与常温透析相比,低温透析能明显减少症状性低血压的发生。其主要原因在于减少透析过程中的温度升高,避免这种温度的升高可望进一步减少低血压的发生。

关键词: 低温透析, 低血压, 相对血容量

Abstract: Objective This study is designed to observe the effects of cool dialysate on decreasing episodes of dialysis-related hypotension. Methods Using self-across method, cool dialysate (35.5℃, group C) and traditional dialysate (37℃, group T) were used for 8~10 dialysis sessions respectively in every 15 hypotension-prone patients. RBV (rdative blood volume, arterial-tube temperature which reflects patient's core temperature, blood pressure, heart rate, ultrafiltration rate and the occurrence of hypotension were observed at every 60-min intervals. Results There are 151 hemodialysis sessions in group C in total and 149 hemodialysis sessions in group T. RBV in both groups decreased gradually during hemodialysis sessions. When hypotension occurred, the average RBV was 78% in group C and 80% in group T. Compared to group T, the eposidic hypotension rate in group C was lower (25.2% vs 39.6%, P=0.002); episodic time was delayed (3.93±0.49 vs 3.66±0.73 hours, P=0.038); ultrafiltration volume increased when hypetension occured (3500.21±843.10ml,3157.28±729.50ml,P=0.035). There were no difference between two groups in RBV and heart rate. Core temperatures increased during hemodialysis, especially in group T. Conclusion Cool dialysate can reduce the episodes of hypotension through decreasing core -temperature changes.

Key words: Hypotension, Relative Blood Volume 