长期应用不同钙离子浓度透析液对血液透析患者血压影响的对照研究

目的 探讨长期应用不同钙离子浓度透析液对维持性血液透析患者血压的影响。方法对近期无低血压发生的15例维持性血液透析患者首先给予钙离子浓度为1．75mmol／L（Dcal．75）的透析液治疗6个月，然后接受钙离子浓度为1．25mmol／L（Dcal．25）的透析液治疗6个月。检测两种透析液单用治疗前以及治疗后1、2、3和4h血清钙、磷、尿素氮和肌酐水平，并记录血压变化。结果 使用Dcal．25透析液单次透析治疗4h，患者的收缩压和舒张压均较透析前下降（P均〈0．05），收缩压较舒张压下降更明显（P〈0．05）；而接受Dcal．75透析液治疗的患者收缩压和舒张压均较透析前升高（P均〈0．05），收缩压较舒张压升高更明显（P〈0．05）。收缩压、舒张压和平均血压与血清总钙的变化均呈正相关（r1=0．326，P1=0．054．r2=0．383，P2=0．037．r3=0．391，P3=0．032）。使用Dcal．25透析液治疗6个月，患者收缩压和舒张压均有所下降，但差异均无显著性（P均〉0．05）；使用Dcal．75透析液治疗6个月，患者血压有所升高，其中收缩压升高显著（P〈0．05）。两种钙离子浓度透析液长期治疗引起的收缩压变化相比差异有显著性（P〈0．05）。结论 单次应用低钙透析可明显降低收缩压，减少高血压的发生率。

Clinical control study of dialysates with different concentrations of calcium on blood pressure in patients under hemodialysis for prolonged period

OBJECTIVE: To investigate the changes in blood pressure in hemodialysis patients treated with low calcium dialysate or high calcium dialysate for long time. METHODS: Fifteen patients undergoing hemodialysis were enrolled in this study. High calcium dialysate (1.75 mmol/L, Dca1.75) was first used for 6 months, then low calcium dialysate (1.25 mmol/L, Dca1.25) was used for 6 months. Serum calcium, phosphate, blood urea nitrogen, and creatinine were measured, blood pressure was recorded before and after hemodialysis at the beginning, and also at 1, 2, 3 and 4 hours after hemodialysis. RESULTS: Compared with that before the treatment, systolic and diastolic blood pressure lowered significantly after single low calcium hemodialysis for 4 hours (both P<0.05), while systolic and diastolic blood pressure rose significantly after single high calcium hemodialysis (both P<0.05). Systolic blood pressure changed more obviously after two hemodialysises (both P<0.05). Changes in systolic, diastolic and mean blood pressure were positively related to changes in serum total calcium (r(1)=0.326, P(1)=0.054; r(2)=0.383, P(2)=0.037; r(3)=0.391, P(3)=0.032). During 6 months of hemodialysis with low calcium dialysate, blood pressure lowered slightly with no significant difference in it (P>0.05), while systolic blood pressure rose during 6 months of hemodialysis with high calcium dialysate (P<0.05). Changes in systolic blood pressure were significantly different between two groups using dialysates with different calcium concentrations (P<0.05). CONCLUSION: Systolic blood pressure and incidence of hypertension decrease after single low calcium hemodialysis.