低温联合钠曲线透析模式预防血液透析中低血压

目的 研究低温联合钠曲线透析模式预防血液透析过程中低血压的发生.方法 26例低血压患者分别采用钠曲线透析、低温透析及联合模式透析,每一患者均行3种透析模式的单盲交叉治疗,连续治疗8次.分析治疗期间患者体质量、血压、肾功能、电解质等的变化,以及自觉症状等.结果 在联合透析模式患者头晕出汗、恶心呕吐和肌肉痉挛症状发生率明显低于其它模式（χ2分别为8.980,11.160,7.100,P＜0.05）.方差结果分析,除联合模式对舒张压无影响外（F =2.08,＞0.05）,其它模式对收缩压和舒张压均有显著变化（F值10.240～26.640,P＜0.01）.相比其它2种模式,低温模式对收缩压和舒张压的影响相对较大.透析后血钠在钠曲线和联合透析模式时略有增高,低温模式透析后血钠明显低于联合模式（t=2.360,P＜0.05）. 结论 低温联合钠曲线模式对患者透析中的血压影响小,更适合有低血压倾向的透析患者,且不影响患者的透析效果.

The hemodialysis modality of low temperature combined with sodium profile for the prevention of hypotension during hemodialysis

Objective To study the hemodialysis modality of low temperature combined with sodium profile （combined hemodialysis） for the prevention of hypotension during hemodilysis.Methods A total of 26 hypotension patients were treated with the sodium profile hemodialysis,low temperature hemodialysis,or combined hemodialysis for 8 sessions.They were then blindly changed to one of the other two hemodialysis modalities.Therefore,every patient underwent the 3 hemodialysis modalities each for 8 sessions.Body weight,blood pressure,renal function,plasma electrolytes,and symptoms were monitored in these patients.Result The prevalence of dizziness,perspiration,nausea,vomiting,and muscle spasms was lower after combined hemodialysis than that after the other two hemodialysis modalities （χ2=8.980,11.16,and 7.10,respectively,P〈0.05～0.01）.Analysis of variance showed that changes of systolic and diastolic blood pressure were present after sodium profile hemodialysis and low temperature hemodialysis （F=10.240 ～26.640,P〈 0.01）,but only systolic pressure （F=2.080,P〉0.05） changed without diastolic pressure changes after combined hemodialysis.Systolic and diastolic pressure changed significantly after low temperature hemodialysis,as compared to the blood pressure changes after the other two hemodialysis modalities.Serum sodium increased slightly after sodium profile hemodialysis and combined hemodialysis.In contrast,serum sodium after low temperature hemodialysis was lower than that after combined hemodialysis （t=-2.360,P〈0.05）.Conclusion Low temperature combined with sodium profile hemodialysis has little influences on blood pressure during dialysis,and is therefore suitable for patients with hypotension during dialysis.