血液透析中静滴小苏打对透析相关症状的影响

目的 探讨血液透析(Hemodialysis,HD)中静滴5％碳酸氢钠溶液对预防糖尿病病人及严重动脉硬化病人所出现的透析相关症状的效果。方法 选择20名高危病人作为研究对象,随机分为两组。A组:行常规碳酸氢盐透析(透析液HCO_3~- 35mmol/L);B组:在行常规血透同时,从静脉管路端滴注5％的碳酸氢钠溶液200～250ml。观察两组病人透析中可耐受脱水速度,有无透析相关症状并记录次数和需要处理的措施和药物剂量次数等、持续监测血压变化和透析效率KT/V、URR。结果 B组病人在使用小苏打后出现透析相关症状的次数明显减少(P<0.05);B组因出现症状采取处理措施的比例为17.5％、A组为93.2％(P<0.05)。透析连续三天的外周血生化检查示B组的酸碱状态优于A组,并维持至下次透析前。结论 常规碳酸氢盐透析在保持正常的酸碱平衡状态方面对糖尿病病人及严重动脉硬化病人是不足的。通过补充5％碳酸氢钠溶液,可减少透析相关症状的发生率。

The effect of administering sodium bicarbonate continuously via the venous line to dialysis - induced symp-toms during standard HD.

Objective To explore the effect of administering 5 % NaHCO3 solution continuously via the venous line to dialysis - induced symptoms during standard HD. Methods We compared 20 high - risk pa-tients which were either treated with standard HD (dialysate 35 mmol/L, treatment A) or treated with Standard HD and additional adiministration of NaHCOs (200 - 250ml 5% NaHCO3 solution over the venous line during HD). Tolerance of ultrafiltration(UF) rate between groups, numbers and treatment of dialysis - induced symptoms during HD were observed and recorded , and t - test was conducted. Results The frequency and treatment of dialysis- induced symptoms reduced during additional infusion of 200 - 250 ml 5%NaHCO3 compared to standard HD. Conclusions We found the metabolic acidosis insufficiently corrected after standard bicarbonate dialysate of 35 mmol/L in diabetic and arteriosclerotic patients. Acid/base status and espe-cially PaCO2 were corrected to normai by individually adapted administration of NaHCO3 during HD. Circula-tory stability due to stimulating the chemoreceptor pathway.