血容量监测运用于血液透析患者干体重评价中的护理

目的分析血液透析患者血容量下降与血压变化对干体重设置的影响。方法来自我院血液透析中心透析过程中进行血容量监测的病人,选择透析结束时血容量下降大于15%共28例,根据是否出现透析相关性低血压分成两组,既A组无透析中低血压和B组透析中低血压。分析两组病人的一般情况、透析状况和临床症状,以及护理观察,及时反馈医师。结果在28例病人中,A组19例(68%),B组9例(32%)。两组病人在年龄、性别、透析龄,血流量及干体重方面无统计学意义。A组病人透析结束时血容量下降为19.79±3.3%,B组为18.99±2.89%,两组间无统计学意义(P=0.51),但两组透析后的收缩压、舒张压、透析中血容量下降=15%时的收缩压、舒张压,以及收缩压、舒张压的最大差值均有统计学意义(P<0.01)。结论密切观察和分析临床症状与血容量监测相结合有助于评价血液透析患者的干体重。     

血液透析中的低血压及其防治

血液透析中低血压（intradialytic hypotension，IDH）是指在血液透析过程中发生的低血压，常表现为三种临床类型；①急性（偶发性）低血压指伴有症状的收缩压突然下降，收缩压〈90mmHg（1mmHg=0．133kpa）或收缩压降幅≥20mmHg；②复发性低血压指至少在50％以上的透析治疗过程中出现低血压，其血压值可参照上述标准；⑧慢性持续性低血压，透析过程中收缩压始终维持在90～100mmHg。常见的IDH症状有肌肉痉挛、晕厥、恶心、呕吐、腹痛，有时会表现为休克或心绞痛、短暂性脑缺血发作，严重时可以出现意识丧失，甚至心肌梗死。作为血液透析过程中最常出现的并发症，IDH在普通透析（conventional hemodialysis，CHD）中的发生率可达20％-30％。IDH直接影响到透析的充分性和患者的生存质量，是增加透析患者死亡率的独立危险因素。     

钠及超滤曲线模式透析对尿毒症患者血容量维持探讨

目的 探讨钠超滤曲线模式透析(PHD)对尿毒症患者透析时的血容量维持作用。方法 选择10例常规血液透析患者,每例患者常规血液透析模式(CHD)与销及超滤曲线透析模式交替进行各5次,观察两种透析模式下患者血容量的变化,同时观察患者血球压积、血压、透析后血浆钠浓度及透析时症状发生率的变化。结果 销及超滤曲线模式透析较普通透析血容量下降明显减少(P0.05),透析中及透析后患者出汗、肌肉痉挛症状明显减少(P<0.05)。结论 钠及超滤曲线模式透析防止了透析患者血容量的明显减少,减少了透析并发症,增加了患者透析耐受性,是一种行之有效的方法。     

钠泵在血液透析低血压中的应用及护理

透析低血压是血液透析中最常见的并发症之一，发生率可达20％～30％。透析低血压的一个重要原因是过多脱水导致的血容量显著下降，血容量下降超过15％时极易发生低血压，而与总体液量下降无关忙。2002年2月-2004年12月，本研究对21例在我科血液净化中心维持性血液透析常发生透析低血压的患者，在透析时使用钠泵400次，以有效地预防低血压的发生，透析1个月后检查透析前后血生化指标．显示血钠浓度变化不明显，现报道如下。     

血液透析中低血压的原因分析及其防治对策

血液透析中低血压是透析中最常见的急性并发症,占20%～30%,是指平均动脉压比透析前下降30mmHg(1mmHg=0.133KPa)以上,或收缩压降至90mmHg以下,伴或不伴低血压的症状.随着人口的老年化,高龄患者增多,透析中出现低血压更为突出,而低血压可使透析治疗不能顺利进行,影响患者透析的充分性.因此,探讨预防血液透析中低血压能使患者得到最合适的透析治疗,提高其生活质量及延长生命,减少病死率.是目前一个需解决的重要课题.我院自2000～2003年共进行血液透析1969例次,透析中并发低血压66例次,现将其发生原因及防治对策报道如下.     

血液透析时急性并发症的监护与处理

1　引　言血液透析是终末期肾脏病的主要治疗手段之一,但血液透析过程中急性并发症的发生率仍较高,这些并发症多数起病急骤而凶险,处理不及时或措施不当将直接威胁患者的生命。本文就血液透析过程中常见急性并发症的监护及处理作一简要介绍。2　急性并发症的监护与处理2.1　低血压血液透析引起的低血压是指平均动脉压比透析前下降4.0kPa(30mmHg)以上或收缩压降至12kPa(90mmHg)以下。血液透析中低血压发生率为25%～40%。发生原因:1超滤量过多或过快,透析时体重下降超过透析前体重的5%以上,致血容量急剧下降,多发生于透析开始1小时后;2长期…     

联合应用可调钠和超滤模式对透析相关低血压的预防作用

随着血液透析设备的不断完善，透析技术也日趋成熟，与透析相关的并发症在不断减少，但是透析相关低血压的发生率仍达20％～30％。所谓透析相关低血压通常指透析中平均动脉压（舒张压＋脉压差／3）比透析前下降30mmHg以上或收缩压降至90mmHg以下，伴或不伴低血压的症状。     

透析性低血压的护理

透析性低血压指患者血液透液过程中平均动脉压比透析前下降 30mmHg以上或收缩压降至90mmHg以下 ,或血液透液前收缩压 <90mmHg、在血液透析中再下降。透析性低血压是血液透析最常见的急性并发症 ,发生率高达 5 0 %～ 70 % [1 ] ,不仅影响血液透析质量 ,还会降低患者的存活率 ,其     

1例维持性血液透析并发低血压患者的护理

低血压是维持性血液透析患者在透析过程中出现的常见并发症之一，发生率为20％～30％，是指平均动脉压比透析前下降4kPa以上，或收缩压降至12kPa以下，伴或不伴有低血压症状。低血压可使透析治疗不能顺利进行，影响患者透析效果。分析血液透析中发生低血压的原因并给予预防护理，可得到最佳的透析效果，提高患者生活质量，延长生命。我科1例维持性血液透析患者。在透析过程中多次并发症状性低血压。严重危及患者生命。     

米多君治疗血液透析中低血压的临床研究--附45例报告

目的：观察米多君(midodrine)防治血液透析中低血压的临床疗效。方法：45例在血液透析治疗中出现低血压的患者，按其出现低血压的情况分为两组：A组29例，透析前血压正常，透析中、后期发生低血压，收缩压下降幅度超过4．0kPa；B组16例，为慢性持续性低血压病人，在血液透析前基础收缩压均偏低(10．7—13．3kPa)，当透析超滤稍多或正常超滤时即出现血压下降，收缩压低于12．0kPa。两组均于每次血液透析前30分钟口服米多君5—7．5mg，观察临床症状及血压变化，对升压效果不显著者于透析开始1小时后加服2．5mg。结果：两组合计显效24例(占53％)，有效12例(占27％)，进步5例(占11％)，无效4例(占9％)，总有效率91％。无明显不良反应。每组治疗前后自身对比，其差异均有统计学意义。结论：米多君治疗血液透析中低血压是有效和安全的。     

肝移植术后早期桡动脉与股动脉有创血压的差异研究

目的探讨肝移植术后早期患者桡动脉与股动脉有创血压监测的差异性。方法选择2015年1月至2015年12月间我院重症医学科收治的肝移植术后患者22例,对肝移植术后入ICU当时至术后1天内8个时间点,同步进行桡动脉和股动脉有创血压监测。根据股动脉收缩压水平分为3组:A组,收缩压(systolic blood pressure,SBP)90~140 mm Hg(1 mm Hg=0.133 k Pa);B组,SBP140 mm Hg;C组,SBP90 mm Hg,测量桡动脉与股动脉有创血压的差值。结果当股动脉收缩压在正常范围内,股动脉与桡动脉的收缩压、舒张压及平均动脉压无明显差异,差异无统计学意义(P0.05);当股动脉收缩压90 mm Hg时,股动脉的收缩压及平均动脉压明显高于桡动脉压,差异有统计学意义(P0.05);当股动脉收缩压140 mm Hg时,股动脉收缩压明显小于桡动脉,差异有统计学意义(P0.05)。结论肝移植术后患者早期低血压及高血压状态下,桡动脉与股动脉有创血压存在较大差异,低血压状态下桡动脉血压监测易低估患者实际血压水平,而高血压状态下表现为高估患者血压水平。     

Beat-to-beat agreement of non-invasive finger artery and invasive radial artery blood pressure in hypertensive patients taking cardiovascular medication

Summary. The aim of this study was to investigate and quantify the agreement between simultaneous and ipsilateral non-invasive finger artery blood pressure (Finapres®) and intra-arterial radial blood pressure among 13 volunteer hypertensive patients, aged 36–71 years and taking cardiovascular medication, during steady-state fluctuation of arterial blood pressure and during an increase in blood pressure induced by static exercise. Eight patients were being treated with beta-blocking agents, eight with calcium antagonists, four with angiotensin-converting enzyme inhibitors, four with diuretics and one with prazosin in combination therapy. Their auscultatory brachial artery blood pressures ranged in systole from 142 to 206 mmHg and in diastole from 88 to 120 mmHg during the treatment. The mean systolic finger artery blood pressure deviated by -14±5 mmHg (P=0.02, mean value±SEM) and the diastolic finger artery blood pressure deviated by 0.6±3 mmHg (P=0.70) from the corresponding radial artery pressure. The maximal beat-to-beat difference between systolic and diastolic finger and radial artery pressure, respectively, showed that a range of less than 10 mmHg in the steady state after individual adjustment for bias. In general, neither systolic nor diastolic differences between the methods exceeded the limits of ±10 mmHg, and the bias did not significantly increase (P≥0.12) during a 10-mmHg increase in arterial blood pressure caused by static exercise. Among three subjects, an increase in bias and poorer agreement was associated with atrial fibrillation and steplike changes in the Finapres output after autocalibration. The results support usage of the Finapres technique to measure beat-to-beat changes of peripheral arterial blood pressure in hypertensive patients taking cardiovascular medication, with a feasible agreement with beat-to-beat radial artery blood pressure.     

血管内支架置放术治疗锁骨下动脉盗血综合征15例报告

目的　总结血管内支架置放术治疗15例锁骨下动脉盗血综合征患者的疗效。方法　15例锁骨下动脉盗血综合征患者,血管造影示锁骨下动脉平均狭窄78.6%,双上肢动脉收缩压差平均为45.6mmHg。经股动脉途径血管内支架置放术13例,经股动脉和肱动脉联合入路双向造影打通狭窄或闭塞并支架置放2例。结果　15例患者的血管内治疗获得成功,术后即刻桡动脉搏动获得改善,双上肢动脉收缩压差平均为16mmHg。无任何病例发生严重并发症。15例患者术后随访6个月,无神经症状复发。结论　采用血管内技术对锁骨下动脉盗血综合征的患者支架置放后其效果可靠,操作相对简单、安全,术后复发率低。     

桡动脉压迫期间血压波动对经皮冠状动脉介入治疗后患者术侧手掌肿胀的影响

目的 探讨经皮冠状动脉介入治疗 (percutaneous coronary intervention,PCI) 患者在桡动脉压迫期间血压变化与术侧手掌肿胀的关系。 方法 选取2018年5月—2020年12月入住南昌市某三级甲等综合医院冠心病病区行桡动脉PCI的患者作为研究对象,对其一般资料和压迫器解压相关指标进行回顾性分析,描述患者在桡动脉压迫期间的血压波动情况,采用单因素回归分析术侧手掌肿胀的影响因素,对患者桡动脉压迫期间血压进行节点分组,分层分析不同血压对术侧手掌肿胀的影响,进一步采用趋势回归分析术侧手掌肿胀发生最高风险时对应的血压范围。 结果 共纳入788例桡动脉PCI患者。对危险因素进行多变量分层分析发现,在有糖尿病史患者中,桡动脉压迫期间收缩压≥130 mmHg (1 mmHg=0.133 kPa) 会增加术侧手掌肿胀发生风险 (OR=1.09,P<0.001),在无论有或无心力衰竭体征和高血压史的患者中,桡动脉压迫期间收缩压>130 mmHg,两组患者术侧手掌肿胀发生风险较一致。趋势回归发现,桡动脉压迫期间平均收缩压为130~149 mmHg时,收缩压每升高10 mmHg,术侧手掌肿胀发生风险增加3.52倍[95%CI (1.37,13.22) ]。 结论 桡动脉压迫期间,患者平均收缩压为130~149 mmHg,发生术侧手掌肿胀的风险最高,建议临床护理人员在制订术侧手掌肿胀并发症预防方案时,应综合考虑患者收缩压变化的因素。     

糖尿病与非糖尿病血液透析患者血压差异的探讨

目的观察糖尿病维持性血液透析患者血压特点及透析中血压的变化。方法选取首都医科大学附属北京同仁医院血液透析中心36例稳定的维持性血液透析患者,分为糖尿病组及非糖尿病组,分析两组患者透析前后血压达标情况及两组间血压的差异,并比较两组患者透析低血压的发生情况。结果血液透析患者血压达标率低,糖尿病组与非糖尿病组患者血压透析前达标率分别为26.7%和28.6%,透析后达标率分别为57.8%和55.6%,两组比较差异均无统计学意义(P0.05)。糖尿病组服用降压药物患者的比例及种类显著高于非糖尿病组(P0.05)。糖尿病组和非糖尿病组患者透析前平均收缩压(systolic bloodpressure,SBP)分别为(163±29)mm Hg(1mm Hg=0.133kPa)和(153±23)mm Hg,脉压(pulse pressure,PP)分别为(83±25)mm Hg和(70±22)mm Hg,两组比较差异均有统计学意义(P0.05),两组平均舒张压(diastolic blood pressure,DBP)差异无统计学意义(P0.05)。透析后糖尿病组患者平均SBP及PP与非糖尿病组差异无统计学意义(P0.05),而平均DBP显著低于非糖尿病组患者,分别为(70±14)mm Hg及(80±15)mm Hg,差异有统计学意义(P0.05)。非糖尿病组患者透析后SBP及DBP较透析前下降幅度分别为(19±29)mm Hg和(3±16)mm Hg,糖尿病组患者相应下降幅度分别为(37±38)mm Hg和(10±17)mmHg,显著高于非糖尿病患者(P0.05)。糖尿病组透析低血压发生率高于非糖尿病组,分别为62.2%和41.3%,症状性低血压发生率也高于非糖尿病组,分别为31.1%和7.9%,两组比较差异均有统计学意义(P0.05)。对可能引起透析低血压的因素进行logistic回归分析,结果显示是否合并糖尿病及总超滤量较高为引起低血压的危险因素(OR=2.572,0.597,均P0.05)。结论维持性血液透析患者血压达标率较低,而糖尿病患者较非糖尿病患者血压更难控制,脉压差更大,透析过程中血压波动大,更易发生低血压。     

Association of diabetes and hemodialysis with ankle pressure and ankle-brachial index in Japanese patients with critical limb ischemia

OBJECTIVE To investigate whether diabetes and regular hemodialysis are associated with false elevation of ankle systolic blood pressure and ankle-brachial systolic pressure index (ABI) because of their arterial calcification in patients with critical limb ischemia (CLI). RESEARCH DESIGN AND METHODS We recruited 269 Japanese patients who underwent endovascular therapy for CLI. Ankle systolic blood pressure and ABI were assessed before endovascular therapy. Arterial stenosis and calcification were evaluated angiographically. We investigated the associations among clinical comorbidities, arterial calcification, and measurements of ankle systolic blood pressure and ABI. RESULTS Ankle systolic blood pressure was 85 ± 56 mmHg, and ABI was 0.59 ± 0.37. Arterial calcification was observed in 69% of the patients. The prevalence of diabetes and regular hemodialysis was 71 and 47%. Diabetes and regular hemodialysis were both significantly associated with the presence of arterial calcification; their adjusted odds ratios were 2.33 (P = 0.01) and 7.40 (P < 0.01), respectively. However, there was no significant difference in ankle systolic blood pressure or ABI level between those with and without these comorbidities. Furthermore, the presence of arterial calcification was not associated with ankle systolic blood pressure or ABI level, whereas arterial stenoses of all segments in the lower body had independent associations with reduced ankle systolic blood pressure and ABI level. CONCLUSIONS Diabetes and regular hemodialysis were significantly associated with arterial calcification, but not with elevated measurements of ankle systolic blood pressure or ABI, in CLI patients.     

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。     

Diastolic pressure in type 2 diabetes: can target systolic pressure be reached without "diastolic hypotension"?

The practicality of vigorous lowering of systolic pressure in diabetes to <130 mmHg remains uncertain. Baseline blood pressure data from several recent trials indicate that, in diabetic subjects, there is nearly a fourfold excess in systolic pressure (the difference between baseline pressure and target pressure) over diastolic pressure with respect to the recommended systolic/diastolic target pressure of <130/80 mmHg. Additionally, systolic pressure was 2-3 mmHg higher and diastolic pressure was 1-3 mmHg lower in diabetic hypertensive than in nondiabetic hypertensive individuals, which adds approximately 4 mmHg to pulse pressure and also to the difference between the excess systolic and excess diastolic pressure. We attempted to force (titrate both systolic and excess diastolic pressure) systolic and diastolic blood pressure to <130/85 mmHg based on Joint National Committee VI guidelines in the setting of a clinical practice in 257 diabetic patients. Although target systolic pressure was attained in a third of this cohort, in 57% of the patients, the attained diastolic pressure was 相似文献   

干体质量调整对维持性血液透析患者合并肺动脉高压的影响

目的 观察维持性血透患者合并肺动脉高压时通过干体质量的调整对肺动脉高压的影响.方法 观察2012年3月至2013年4月在湖北医药学院附属太和医院肾病内科维持性透析120例患者中18例合并肺动脉高压患者,透析龄均超过1年,平均透析年龄3.41±1.23年,其中男性12例,女性6例,平均年龄47.44±6.13岁.病因慢性肾小球肾炎10例,糖尿病肾病5例,高血压良性小动脉肾硬化症2例,肾结核1例.所有患者均行常规血液透析,每周透析3次,使用聚砚膜1.4m2透析器.所有患者均行超声心动图检测肺动脉收缩压（PASP）≥35mmHg,确诊肺动脉高压后,观察治疗前患者血压、血红蛋白、血磷、甲状旁腺激素、血浆脑钠肽、利用超声心动图检测右房横径、右房长径、肺动脉内径、肺动脉收缩压,通过下调干体质量1月后再次复查上述指标. 结果 通过下调干体质量后,所有患者治疗后肺动脉压力为42.00±6.75mmHg较治疗前48.00±8.15mmHg明显下降,有显著意义（P＜0.05）,血浆脑钠肽浓度由治疗前7467.8±2357.4 pg/ml下降至4759.2±1367.9 pg/ml,治疗后,右房横径（26.84±4.23mm）、右房长径（35.96±8.69mm）、肺动脉内径（21.64±2.49mm）较治疗前（32.19±7.93mm、43.09±8.95mm、25.18±4.06mm）缩小,有显著统计学意义.左心室内径（50.25±5.39mm）较治疗前（56.15±6.28mm）明显缩小,左心室射血分数（55.3±13.6％）较治疗前（43.2±12.3％）明显升高,有显著统计学意义（P＜0.05）.下调干体质量后对患者血压、血红蛋白、血甲状旁腺激素、血钙浓度、血磷浓度与治疗前比较无显著统计学意义（P＞0.05）.结论维持性血液透析患者合并肺动脉高压可通过下调干体重,清除体内过多水分,缩小右心房横径及肺动脉内径,降低肺动脉压力.缩小右心室内径,减轻对左心室挤压,缩小左心室内径,增加左心室射血分数,明显改善左心室收缩功能.     

Blood pressure in the puerperium

Blood pressure was measured by random zero sphygmomanometer in the morning and afternoon for 5 days after normal delivery in a group of 136 previously normotensive women. The number of women studied each day varied from 32 to 125. The afternoon blood pressure was higher than the morning blood pressure (differences: 1.7 mmHg systolic, 2.6 mmHg diastolic; P less than 0.05). Both systolic and diastolic blood pressures rose for the first 4 days after delivery. The average rise over the whole period was about 6 mmHg systolic and 4 mmHg diastolic (P less than 0.05). A considerable number of previously normotensive women displayed elevations of blood pressure in the puerperium. Twelve per cent of all patients exceeded a diastolic blood pressure of 100 mmHg.