可调钠联合不同超滤模式在预防透析中低血压中的应用

目的观察维持性血液透析患者在6种不同透析方案下透析中低血压(intradialytic hypotension,IDH)的发生情况,探讨有效预防IDH的透析方案。方法 20例维持性血液透析患者,于研究前1个月筛选期将干体质量、透析参数等调整稳定。选取线性钠模式(Na-1)及梯度钠模式(Na-2)联合线性超滤模式(UF-1)、间歇性超滤模式(UF-2)及梯度超滤模式(UF-3)组成6种透析方案,各患者依次进行标准透析模式(对照组)及6种透析方案各2周,比较分析各方案下透析中血压变化、IDH发生率及干体质量未达标率的情况。结果①6种透析方案患者透析3h、4h的平均动脉压(MAP)显著高于对照组(q=4.15～7.20,P<0.05),其中方案2(Na-2+UF-1)和方案4(Na-2+UF-2)明显高于其余方案(q=3.90～5.87,P<0.05);②与对照组相比,6种透析方案IDH发生率均降低(χ2=5.26～12.90,P<0.05),且方案2和方案4明显低于其余方案(χ2=4.07～6.36,P<0.05);③透析方案3(Na-1+UF-2)、方案4(Na-2+UF-2)患者干体质量未达标率较其余各方案显著降低(χ2=7.95～19.80,P<0.05)。结论梯度钠模式(Na-2)与间歇性超滤模式(UF-2)相结合的透析方案在显著降低IDH发生率的基础上干体质量达标率较高,可作为预防维持性血液透析患者发生IDH的有效方法。

The application of the coalition of adjustable sodium and ultrafiltration profiles on intradialytic hypotension

Objective To explore the preventive measures to intradialytic hypotension （IDH） in maintenance hemodialysis patients by comparing the effect of six hemodialysis schemes. Methods The six hemodialysis schemes included linear sodium profile （Na-1） or stepwise sodium profile （Na-2） combined with one of the three ultrafiltration patterns, i.e, linear ultrafiltration pattern （UF-1）, alternative high/low ultrafiltration pattern （UF-2）, or stepwise pattern （UF-3）. We observed 20 stable hemodialysis patients, who first used the standard dialysis scheme, and then sequentially used one of the six hemodialysis schemes each for 2 weeks. Changes of intradialytic blood pressure, prevalence of IDH, and prevalence of failure to achieve the dry weight during dialysis sessions were analyzed. Results ① In patients in the stage using the six hemodialysis schemes, the intradialytic mean arterial pressure （MAP） at 3 and 4 hours after dialysis increased significantly and the prevalence of IDH was significantly decreased, as compared with those in the stages using the standard dialysis scheme. ② Hemodialysis schemes 2 （Na-2＋UF-1） and 4 （Na-2＋ UF-2） improved MAP and reduced IDH rate better than other schemes. ？Hemodialysis schemes 1 and 2 reduced the prevalence of failure to achieve the dry weight remarkably. Conclusions In hemodialysis patients, the stepwise sodium profile （Na-2） combined with the alternative high/low ultrafiltration pattern （UF-2） can reduce the prevalence of IDH with sufficient ultrafiltration volume. Therefore, this dialysis scheme can be used as an effective method to prevent IDH.