低温可调钠透析联合左卡尼汀对维持性血液透析患者透析中低血压的影响

目的采用前瞻性自身配对研究，观察低温可调钠透析联合左卡尼汀对维持性血液透析患者透析中低血压的影响。方法在郑州大学第一附属医院透析的64例易发生透析中低血压维持性血液透析（MHD）患者，在接受常规血透（A组）6月后，改为左卡尼汀联合低温可调钠透析（B组）6月。观察两组治疗期间透析中低血压发生率、平均动脉压水平、血清钠浓度、C反应蛋白水平以及内瘘闭塞和心血管事件发生率。结果30例患者治疗前后平均动脉压升高，低血压及症状性低血压发生率明显减少（P〈0．05），内瘘闭塞及心血管事件发生率下降（P〈0．05），C反应蛋白明显下降（P〈0．05）。但患者透析前后血清钠水平及尿素氮清除率比较无差异性。结论应用左卡尼汀联合低温可调钠透析可有效改善透析中低血压的发生率，减少内瘘闭塞及心血管事件发生率，并能改善微炎症状态。

Effects of levocarnitine and adjustable sodium concentration at low temperature on hypotension in dialysis

Objective To observe the effect of levocarnitine on hypotension in dialysis combined with hypothermia ad- justable sodium. Methods Totally 64 mintenance hemodialysis patients who accepted routine hemodialysis months （group A） were given levocarnitine united with hypothermia adjustable sodium dialysis（group B） in succession respec- tively six months, using self - matched pair study. Observed the incidence rate of hypotension, mean arterial pressure, ser- um sodium concentration, urea clearance rate, C reactive protein,incidence of fistula occlusion and cardiovascular events. Results All patients＇ mean arterial pressure elevated, C reactive protein, incidence of hypotension, fistula occlusion and cardiovascular events descend（ P 〈 0. 05 ）after treatment. But there was no difference before and after dialysis in the ser- um sodium concentration and urea clearance rate. Conclusion Using levocarnitine united with hypothermia adjustable sodium dialysis at low temperature can decrease the incidence rate of hypotension, fistula occlusion and cardiovascular e- vents effectively, improve the micro- inflammatory state.