盐酸米多君治疗透析中低血压２１例疗效观察.DOCVIP

临床医学论文-盐酸米多君治疗透析中低血压２１例疗效观察 ???????????????????? ?? 作者：辛智利　曾春艳　多景华 　　【摘要】 目的 观察盐酸米多君对血液透析(HD)中低血压的疗效。方法 选择呼伦贝尔市人民医院透析室维持血液透析患者21例，进行为期6周的盐酸米多君口服治疗。用药方法：于透析开始后1 h服用米多君5 mg。每次HD前、HD中、HD后测定患者血压、心率、观察患者的状况。每次HD前后测体质量、记录超滤量。症状及程度采用5分制评分，并于治疗前对比。结果 与应用盐酸米多君前比较，患者HD中及HD后的最低收缩压、心率、总超滤量的差异有统计学意义(P0．01)。盐酸米多君治疗HD中低血压显效4例(19．0%)，有效8例(38．1%)，进步6例(28．6%)，总有效率为85．7%。头昏、胸闷、心悸等主要症状评分，盐酸米多君治疗后于治疗前比较差异有统计学意义(P0．01)。无1例患者出现不良反应。结论 盐酸米多君治疗HD中低血压安全有效。 　　【关键词】米多君；低血压；血液透析 　　 　　 　　【Abstract】 Objective To evaluate efficacy of midodrine in treatment of intradialysis hypotension(IDH)in maintenance hemodialysis patient(MDH).Methods 21 MHD patients with IDH were given 1 hour after the beginning of hemodialysis,the treatment maintained for 6 weeks,if systolic blood pressure(SBP)increased less than 20 mm Hg.The pre-,intra-,post-hemodialysis blood pressure and heart rate,the pre-and post-hemodialysis body weight,the ultrafilitrated volume of each dialysis,the pre-and post-hemodialysis body weight,the ultrafiltrated volume of each dialysis,the pre-and post-treatment liver and renal function and electrocardiogram were measured and recorded.The symptoms of IDH were observed.Results Compared to those before treatment with midodrine hydrochloride，the minmum intradialysis SBP and heart rate at that time,the post-dialysis SBP and heart rate,and total ultrafiltrated changed significantly(P0．01).The total effective rate was 85．7%.And the symptoms of IDH were improved significantly(P0．01).No side effects were found in those patients.Conclusion Midodrine is safe and effective for the treatment of IDH 　　【Key words】Midodrine；Hypotension；Hemodialysis 　　 　　低血压是血液透析(HD)过程中的急性并发症之一，其发生率达20%~30%[1]。低血压的临床表现轻者出现乏力、头昏眼花、出冷汗，也可无任何症状，仅测量时发现血压降低；重者可出现面色苍白、肌肉痉挛、心律失常，甚至意识丧失、死亡。如不及时处理，可危及患者的生命。其常见的不良后果包括：1．影响透析的进行及疗效；2．诱发心律失常、心绞痛等并发症；因肾血流量减少导致肾功能进一步下降；也可导致内瘘功能的丧失。盐酸米多君是一种α1肾上腺素能受体激动剂，可收缩动静脉容量血管、升高血压并防止血液在静脉内淤积。笔者采用口服盐酸米多君治疗透析中的低血压，疗效良好，现报道如下。 　　1 一般资料 　　1．1 对象 选取2006年3月至2007年3月在本院透析室行维持血液透析治疗的患者21例。其中男12例，