透析中的高血压-培训课件.ppt

EPO 用量的调整 对红细胞压积上升过快的透析高血压患者，应当减少EPO 的用量，以避免其带来的血液粘稠度和外周血管阻力增加，达到血红蛋白靶目标的患者应改为维持剂量皮下注射。 Krapf, Clin. J. Am. Soc.Nephrol. 4, 470–480 (2009） Why Not Meals During Dialysis? 1）欧洲国家常规给予患者透析中食品和点心，透析高血压发生率低，患者血清白蛋白水平高，透析低血压发生率并没有因此增高。 2）进食 低血压 进食治疗透析中高血压 Kamyar Kalantar-Zadeh, MD, MPH, PhD October 16, 2009 29th Annual Dialysis Conference 小 结 透析中高血压的潜在机制 1. 容量超负荷 2. 心输出量增加 3. RAS系统激活 4. 交感神经系统兴奋及血管反应 5. 肽类物质变化：NO ET-1 6. 电解质变化：Na K Ca 7. 由超滤引起的红细胞压积增加、血液黏滞度增加 8. 降压药的透析清除 透析中高血压的治疗 1. 减少容量负荷：限盐限水、增加超滤 2. 保持电解质平衡：低钙透析 3. 减少交感神经兴奋：ACEI、ARB、肾素抑制剂、α?blockers、 β?blockers、每日透析、长时间透析、夜间透析 4. 抑制RAS系统活性： ACEI、ARB、肾素抑制剂 5. 调整降压药物：联合用药、根据透析清除补充药量 6. 促红素剂量调整 7. 高血压急重症处理：静脉用药、双肾切除、肾去神经支配 研究动态 Mechanism and Treatment of Intradialytic Hypertension 结 语 谢谢大家！ * * Primary Diagnoses for Patients Who Start Dialysis Talking Points: Diabetes is the major cause of end-stage renal disease (ESRD). Hypertension is the second most common cause. But, a substantial proportion of diabetics will have hypertension (blood pressure 140/90 mm Hg) as an important contributing factor to their loss of renal function. ? References: United States Renal Data System (USRDS) 2000 Annual Data Report. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases – Division of Kidney, Urologic and Hematologic Diseases. USRDS Coordinating Center operated by the Minneapolis Medical Research Foundation. Internet Address: * Large observational studies describe a U shaped mortality curve with regard to BP in dialysis patients. Not do they fail to demonstrate a correlation between worse outcome and significant hypertension, but they demonstrate increased mortality at lower BP. Is the hemodialysis population truly unique in that hypertension somehow provide