›› 2010, Vol. 9 ›› Issue (1): 50-53.

• 血液净化相关产品与技术 • 上一篇    下一篇

超声稀释监测血液透析期间低血压的临床价值

代文迪 张东亮 刘文虎   

  1. 首都医科大学附属北京友谊医院肾内科
  • 收稿日期:2009-08-28 修回日期:1900-01-01 出版日期:2010-01-12 发布日期:2010-01-12

The relationships of circulating blood volume,cardiac output,peripheral vascular resistance when hypotension in haemodialysis by ultrasound dilution

DAI Wen-di ZHANG Dong-liang LIU Wen-hu ,   

  1. Department of nephrology of friendship hospital of Beijing
  • Received:2009-08-28 Revised:1900-01-01 Online:2010-01-12 Published:2010-01-12

摘要:

【摘要】 目的 利用超声稀释的方法监测血液透析期间低血压患者的有效血容量、心输出量(CO)、外周血管阻力(PVR)的变化,了解低血压患者的血液动力学变化。方法 采用超声稀释的方法对20例维持性血液透析中出现复发性低血压的病人进行透析前后心输出量、心脏指数(CI)、中心血容量(CBV)、外周血管阻力对比分析;并在出现低血压后分别给与强心药和高浓度葡萄糖干预治疗及调整干体重后观察上述各项指标的变化。 结果 血液透析中患者低血压与ΔCBV和ΔCO直接相关(P <0.05),而ΔPVR变化虽有升高趋势,但无统计学差异(P > 0.05);强心剂和高浓度葡萄糖干预治疗后ΔCBV[(0.04±0.06) V (0.11±0.04) P<0.05]和ΔCO有显著性差异[(0.33±0.15) V (0.70±0.16) P<0.05]。调整干体重前后,透析3小时ΔCO有明显升高[(-1.63±0.68) V (-0.91±0.34) P<0.05]。 结论 血液透析期间低血压与有效血容量、心输出量直接相关,与外周血管阻力、心肌储备功能关系不明显。超声稀释方法是一种简便、非侵入性监测血液透析患者心功能及血液动力学改变的方法,对预防透析低血压有积极地作用。

关键词: 超声稀释, 血液透析, 低血压, 心脏功能

Abstract:

【Abstract】 Objective To research dialysis patients haemodynamics change who often intradialytic hypotension by measured the effective circulating blood volume (CBV)、cardiac output(CO)and peripheral vascular resistance (PVR) with Ultrasound dilution method. Methods we measured 20 patiernts about the changes of center blood volume、cardiac output、cardiac index(CI)and peripheral vascular resistance before and after haemodialysis who often intradialytic hypotension by HD02 Haemodialysis monitor during haemodialysis session.Further we compare the changes of those index when we give high concentrate dextroglucose、 metrazol and adjust patients’dry weight respectively. Results the decisive factor of intradialytic hypotension are changes of CBV(ΔCBV) and CO(ΔCO) (P < 0.05), though the changes of PVR has also increase, but has no significant difference (P >0.05).When we compare the change between high concentrate dextroglucose and metrazol,we get the result that the former can increase CBV and CO significantly, have significant difference in ΔCBV[(0.04±0.06) V (0.11±0.04) P< 0.05) and ΔCO (0.33±0.15 V 0.70±0.16 P < 0.05). 3hΔCO have significant increased (-1.63±0.68 V -0.91±0.34 P < 0.05)at haemodialysis 3 hour after adjust dry weight. Conclusions The decisive reasons of intradialytic hypotension are reduction of effective circulating blood volume and cardiac output ,but not PVR and myocardial reserve. Ultrasound dilution is a simple、non-invasive method to monitor cardiac function during haemodialysis session and supply evidence for intervening treatment. Ultrasound dilution can also be applied for prevetion of intradialytic hypotension.

Key words: Haemodialysis, Hypotension, Cardiac function