血容量监测下的干体重实时调整

目的探讨在血透过程中利用在线血容量监测技术准确调整干体重的可能性。方法测定100位患者透析中血容量的下降值和低血压的发生数。结果血容量下降小于10%者共28例,无一例发生低血压。血容量下降在10%~15%者16例,低血压1例。血容量下降15%~20%者32例,低血压5例。血容量下降大于20%者13例,低血压6例。血容量平均下降速率第1小时为4.86%,第2小时为8.24%,第3小时为11.59%,第4小时为13.82%。并对血容量下降小于5%者增加超滤总量50%或1 L,血容量下降5%~10%者增加超滤总量25%或0.5 L,通过适当调整,干体重可较前下降3~5 kg。结论在线血容量监测技术可监测患者血容量变化,对血容量进行实时安全的调整,尽可能避免了透析中的低血压和心血管的不稳定性;并可指导过多水分的清除,减轻了心血管系统的容量负荷和透析间期的高血压。

The adjustment of dry weight under blood volume monitoring

Objective To evaluate the efficacy of blood volume monitoring(BVM) on adjusting dry weight accurately during hemodialysis.Methods 100 cases were observed in our study.The decrease of blood volume(BV) and the frequency of hypotension were measured during the hemodialysis sessions.Results 28 cases had less than 10% decrease in BV.There was no hypotension presented;16 cases had 10%～15% decrease in BV,One case presented hypotension;32 cases had 15%～20% decrease in BV,5 cases presented hypotension;13 cases had greater than 20% decresse in BV,6 cases presented hypotension.The average rate of the BV decreased:the first hour by(4.86)%,the second hour 8.24%,the third hour 11.59%,the fourth hour 13.82%.The ultrafiltration volume was increased 50% or 1 liter for the patients with the BV decrease less than 5%.The ultrafiltration volume was increased by 25% or 0.5 liter for the patients with the 5%-10% of BV decreass.After receiving adjustment,the dry weight of these patients was decreased by 3～5 kg.Conclusions The BVM can offer us a window to observe the change of the patients' blood volume,which is helpful to avoid the intradialysis hypotension and keep hemodynamic stability and prevent from the fluid overload and treat the interdialysis hypertension.