组合型人工肾技术预防血液透析中低血压效果观察

目的探讨血液透析联合血液灌流的组合型人工肾技术预防透析中低血压的效果。方法对42例血液透析中反复发生低血压的患者实施组合型人工肾技术。并与常规血液透析进行比较。结果组合型人工肾技术实施后中分子物质甲状旁腺激素显著低于实施前（P〈0．01）．两种透析方式下患者透析2h、3h血压比较，差异有显著性意义（均P〈0．01）。结论血液灌流联合血液透析的血液净化治疗方式能较好地预防透析中低血压的发生。其机制有待进一步研究。     

组合型人工肾治疗尿毒症患者皮肤瘙痒的效果观察

目的探讨组合型人工肾治疗尿毒症患者皮肤瘙痒的效果及护理方法。方法选择50例尿毒症伴皮肤瘙痒的维持性血液透析患者,随机分成对照组与观察组各25例,分别采用组合型人工肾治疗与常规血液透析8周。治疗前后检测甲状旁腺素水平,观察皮肤瘙痒改善情况。结果观察组治疗后甲状旁腺素水平显著低于对照组,皮肤瘙痒改善情况显著优于对照组(P0.05,P0.01)。结论组合型人工肾能有效地清除甲状旁腺素等大中分子毒素,改善患者的皮肤瘙痒症状;透析中防止感染、凝血,正确回血等是其护理要点。     

组合型人工肾治疗尿毒症患者皮肤瘙痒的效果观察

目的探讨组合型人工肾治疗尿毒症患者皮肤瘙痒的效果及护理方法。方法选择50例尿毒．症伴皮肤瘙痒的维持性血液透析患者,随机分成对照组与观察组各25例,分别采用组合型人工肾治疗与常规血液透析8周。治疗前后检测甲状旁腺素水平,观察皮肤瘙痒改善情况。结果观察组治疗后甲状旁腺素水平显著低于对照组,皮肤瘙痒改善情况显著优于对照组（P〈0．05,P〈0．01）。结论组合型人工肾能有效地清除甲状旁腺素等大中分子毒素,改善患者的皮肤瘙痒症状;透析中防止感染、凝血,正确回血等是其护理要点。     

组合型人工肾相关性低血压的原因及护理

目的 探讨组合型人工肾在治疗中发生低血压的原因和护理措施.方法 采用静脉滴注高渗溶液,控制透析脱水量,提高透析液钠的浓度,合理用药,根据患者的具体情况选择合适的透析器、灌流器型号和管路等,从而预防并治疗透析中出现的低血压.结果 维持血液透析患者28例,共行3320例次血液透析,232例次组合型人工肾治疗,其中186例次(18％)在治疗中出现低血压,经治疗处理后血压恢复正常,可继续治疗,无1例死亡.结论 治疗过程中应认真观察患者的不同症状,掌握发生的规律,及时采取不同的防治措施,是治疗组合型人工肾中低血压的关键.     

血液透析中低血压的预防及护理

血液透析(ＨＤ)中发生低血压是由多种因素共同作用的结果,据文献报道,ＨＤ中低血压发生率占20%～30%[1],这不仅影响ＨＤ的顺利进行,降低效果,甚至危及病人生命。1998年4月至1999年1月我院50例肾功能衰竭病人进行ＨＤ456例次,发生低血压27例次,占ＨＤ的59%,明显低于文献报?..     

组合型人工肾对维持性血液透析患者微炎症的影响

目的探讨组合型人工肾对维持性血透(maintenance hemodialysis,MHD)患者微炎症状态的影响.方法将42例MHD患者随机分为组合型人工肾组(HD+HP)组和血液透析(HD)组,2组患者在首次治疗前后及HD+HP治疗8w后分别观察两组患者TNF-α、IL-6、CRP水平的变化.结果 HD+HP组治疗后TNF-α、IL-6水平显著降低(P＜0.01),CRP水平降低(P＜0.05).治疗8w后复查与首次治疗后轻度降低,但无统计学意义(P＞0.05);HD组治疗前后TNF-α、IL-6、CRP水平无统计学意义(P＞0.05).结论组合型人工肾能有效可以改善MHD患者的微炎症状态.     

密闭式空气回血在组合型人工肾灌流器卸载中的应用

目的探讨组合型人工肾中血液灌流器卸载安全、有效、方便的方法。方法对39例共234例次行组合型人工肾治疗的患者采用密闭式空气回血法(密闭法,117例次)与传统空气回血法(传统法,117例次)卸载灌流器的操作方法进行自身比较。结果密闭法热原反应发生率为0.85%,透析器凝血发生率为4.27%,卸载所需时间为(2.17±0.03)min,传统法分别为11.11%、19.66%、(4.36±0.07)min,两者比较,差异有统计学意义(均P<0.01)。结论密闭式空气回血法操作安全、简便,可降低热原反应发生率及透析器凝血发生率,提高血液透析安全性,且可提高工作效率。     

血液透析中低血压的预防及护理

目的:探讨血液透析中如何防治低血压的发生.方法:来用一系列预防、治疗及护理措施,高/低钠序贯透析法预防血液透析中低血压的发生.结果:透析中低血压的发生率明显降低(约为10％～15％),透析效果与生存质量明显改善.结论:采取有效地预防及护理措施是降低血液透析中低血压发生、保证透析效果的关键,对提高患者的存活率和生活质量有重要意义.     

组合型人工肾在透析患者肾性贫血中的疗效观察

目的:探讨组合型人工肾(HP/HD)在治疗血液透析患者肾性贫血中的临床疗效。方法:将维持性血液透析1年以上的患者60例随机分为普通透析HD组30例,组合型人工肾(HP/HD)组30例。HD组采取维持性HD治疗,每周透析3次,每次透析4h,组合型人工肾(HP/HD)组每周行1次HP/HD,HD治疗2次,时间均4 h。所有患者均在上机治疗前后及6个月后空腹采血,观察两组各项指标的变化。结果:治疗后组合型人工肾(HP/HD)组中大分子量毒素β2-MG、iPTH与HD组比较明显下降,与HD组比较Hb明显升高,有统计学差异(P<0.05)。结论:组合型人工肾(HP/HD)增加了对中大分子量毒素的清除,治疗肾性贫血效果优于普通HD。     

规律血液透析中低血压的观察和护理

目的:探讨血液透析过程中低血压的相关的相关原因及护理方法.方法:对我院2008年～2011年40例血液透析发生低血压的原因及采取相应的护理措施.结果:超滤脱水量与透析低血压之间明显相关,贫血越严重及心功能不全的患者发生低血压较多.结论:采取有效地预防及护理措施是降低血液透析中低血压发生、保证透析质量的关键.     

Preservation of Blood Pressure Stability with Hypertonic Mannitol during Hemodialysis Initiation

Background: Intradialytic hypotensive events are common among hemodialysis patients and are associated with a variety of patient- and procedure-related factors, including intradialytic decline in plasma osmolality. Prior studies and practice have suggested that administration of osmotically active drugs may ameliorate blood pressure decline during chronic hemodialysis. Methods: Clinical and treatment data were collected for 102 consecutive patients requiring initiation of renal replacement therapy in 2 major teaching hospitals. Routine administration of mannitol differed according to institutional protocols, allowing its examination as the primary exposure of interest. Generalized linear models were fit to estimate associations of mannitol use during dialysis initiation with intradialytic blood pressure, as assessed by: (1) intradialytic blood pressure decline; (2) nadir intradialytic blood pressure; (3) absolute systolic blood pressure <90 mm Hg or decline >20 mm Hg. Results: Mean age was 62 years (±16), 70% were male and 44% were diabetic. Mean predialysis and nadir systolic blood pressure were 142 mm Hg (±29) and 121 mm Hg (±26), respectively. Mannitol administration was associated with a lesser decline in intradialytic blood pressure, a higher nadir blood pressure and fewer hypotensive events requiring intervention. No effect modification was evident according to diabetes or acuity of kidney disease (chronic vs. acute). Conclusions: Mannitol administration appears to preserve hemodynamic stability during hemodialysis initiation. Randomized controlled trials are needed to confirm these findings and identify optimal management strategies to prevent intradialytic hypotension.     

Blood Pressure and Heart Rate Variability in Patients on Conventional or Sodium-Profiling Hemodialysis

Background. Autonomic nervous system dysfunction and dialysate sodium (Na) concentration are believed to play a role in the pathogenesis of hemodialysis-related hypertension. The present study was undertaken to determine whether increases in blood pressure in hemodialysis patients are associated with changes in heart rate variability (HRV), a measure of the autonomic nervous system function, and long-term exposure to increased dialysate Na concentration. Methods. Baseline clinical, biochemical data and HRV of patients undergoing increased Na profiling dialysis (High-Na, n?=?9) and on conventional treatment (Control, n?=?11) were compared with those obtained after one year of study. Results. After one year, the mean predialysis systolic blood pressure (SBP) increased in seven patients of the High-Na and in five of the Control group, and decreased or remained unchanged in the remaining subjects. Initial HRV was significantly higher in patients with increased SBP, and it increased further in these patients after one year. At the end of the study, post-dialysis plasma Na, osmolality, and weight gains were significantly higher in the High-Na group. No significant correlation, however, was found between individual changes in intradialytic sodium elimination and the alterations in blood pressure. Conclusion. These data suggest that the dialysate sodium concentration, a most important determinant of interdialytic weight gain and fluid balance, is only partly correlated with long-term changes in blood pressure. An increased blood pressure over time may develop in a subset of hemodialysis patients with higher HRV, suggestive of increased sympathetic activity.     

股动脉-股深动脉人工血管旁路术建立长期血透通路14例报告

目的：探索一种适合传统方法难以建立自体动静脉内瘘和人工动静脉内瘘患者的新的血管通路建立方法,确保该部分透析患者血管通路的安全。方法：对我院2012年1月以来14例因自体血管条件差、周围血管耗竭等原因无法建立自体动静脉内瘘,而以人工血管动静脉内瘘方式建立移植血管通路则存在缺乏合适的静脉吻合口的患者,采用股动脉一股深动脉人工血管旁路术建立长期血透通路,并观察术后并发症、通畅率、血流量等以评估该种通路的可靠性、安全性。结果：14例患者均一次手术成功,随访2～13个月,通畅率100％,血流量达250～300ml／min,1例因透后压迫不当出现皮下血肿,1例发生切开处感染。1例发生切口脂肪液化。未发生血栓形成、狭窄、人工血管感染、肢体肿胀、心功能不全等并发症。结论：股动脉一股深动脉人工血管旁路术建立长期血透通路具有手术操作简单、符合生理、血流量充分、穿刺部位多、术后无静脉高压、不增加心脏负荷等优点。为传统方法难以建立长期血管通路的患者提供了一种全新的血管通路选择,具有一定的应用前景。     

Blood Pressure Recordings During Hemodialysis Access Interventions: Implications for Acute Management

A retrospective study evaluating the pattern of blood pressure and its related complications before, during, and after percutaneous hemodialysis interventions was performed in patients presenting with asymptomatic hypertension. Hemodialysis patients undergoing percutaneous interventions including tunneled hemodialysis catheter insertion, percutaneous balloon angioplasty and thrombectomy procedure, and stage II hypertension (systolic blood pressure ≥160 mmHg) were included in this analysis. Blood pressure medications were not used while midazolam and fentanyl were routinely administered. Patients were followed for up to 4 weeks to monitor any complications. The mean blood pressure before, during, and after the procedures were 185 ± 18/96 ± 14, 172 ± 22/92 ± 15, and 153 ± 25/87 ± 14, respectively. There was a statistically significant difference between the blood pressure readings before and after the procedure (before = 185 ± 18/96 ± 14, after = 153 ± 25/87 ± 14; p = 0.001). None of the patients had a stroke, myocardial infarction, or acute pulmonary edema before, during, or after the procedure or during the 4‐week follow‐up period. A significant reduction in blood pressure was observed after the procedure without the administration of any antihypertensive medication. These results suggest that the reduction in blood pressure observed after percutaneous dialysis access interventions (particularly in the presence of midazolam and fentanyl) may make it unnecessary to treat asymptomatic hypertension prior to these procedures.