血液透析中低血压的不同防治方法的比较研究.docxVIP

血液透析中低血压的不同防治方法的比较研究 蒙海燕（上海市第一人民医院宝山分院血透室 上海 200940） 摘要：目的:木研究旨在评估防治血液透析中低血压发生（IDH）的不同方法的 效果。方法：我们从上海交通大学附属第一人民医院宝山分院血液净化中心长 期规律透析患者中选取16例透析中低血压患者。每一位患者首先进行三期标准 血液透析治疗，透析标准如下：使用纤维素膜透析器，碳酸盐透析液，其中透析 液钙浓度1.75mmol/L,钠浓度140mmol/L,透析液温度37°C。随后患者进行连 续5期不同的血液透析模式治疗，其中包括：高钠透析液（固定钠浓度144 mmol/L）；钠梯度透析液（钠浓度152?138 mmol/l）；续贯透析模式（标准3小 时透析，之后予以1小时超滤治疗）；低温透析（透析液温度t;37°C）；低温透 析联合钠梯度透析液模式。其中有12例（78% ）患者每周行2期，每期5小时 透析治疗。透析间期平均收缩压（SAP）为110.7plusmn;5.6 （100.1-125.5） mmHg；其中有2例患者接受抗高血压治疗。结果：与标准透析模式比较，低 温透析联合钠梯度透析液模式与单纯低温透析液模式中发牛IDH的次数较少。 结论：我们认为血液透析中使用低温透析联合钠梯度透析液模式或单纯低温透 析液模式治疗患者，可能是减少IDH发生次数和医疗干预均次的最佳方法。 关键词：血液透析；低血压；慢性肾功能衰竭。 Comparison of prevention methods of intradialytic hypotension MENG Hai-yan. Department of dialysis center, Baoshan Division of the ISt Peoplersquo;s Hospital affiliated to Shanghai Jiao Tong University. [ABSTRACT] Objective Our study evaluates the effectiveness of the different methods of prevention of intradialytic hypotension （IDH）. Methods We studied 16 hemodialysis patients who developed IDH at Baoshan Division of the ISt Peoplersquo;s Hospital affiliated to Shanghai Jiao Tong University. Each patient underwent three standard sessions with cellulose diacetate dialysers and bicarb on ate dialysate with calcium concen trati on of 1.75mmol/L and sodium (Na) concentration of 140 mmol/L, with dialysate temperature (T) of 37°C. Then the patients were subjected to five successive sessions, each time using one of the following protocols: fixed Na dialysate concentration at 144 mmol/L, Na ramping from 152 to 138 mmol/L, one hour of ultrafiltration (UF) alone followed by three hours of standard dialysis session, dialysis with standard dialysate at T lt; 37 °C, or a combi nation of Na ramping and cold dialysate. Twelve (78%) patie nts un derwent two sessions of HD per week of five hours each? The mean systolic blood pressure (SAP) in the interdialytic period was 110.7plusmn;5.6 (100.1-125.5) mmHg; two patients underwent anti-hypertensive treatment. Results The combinat