持续测定血容量变化以减少血液透析中并发症的可行性研究

目的　研究血液透析中监测相对血容量 (BVM ,Bloodvolumemonitoring)并反馈调控超率速度的方法对减少血液透析中常见并发症发生率的效果。方法　 30例维持性血液透析患者 ,采用普通方式与监测BVM反馈调控超率速度方式 (BVM法 )交替进行血液透析 ,统计BVM法血液透析与普通血液透析次数、发生了低血压和小症状 (肌肉痉挛疼痛、或头痛、或呕吐、或腹痛 )的血液透析次数以及治疗前后血压每次超率量。比较两种方法间各项指标的差异。结果　 4年内 30例患者共做普通血液透析 6 5 5 0次 ,有低血压发生的血液透析次数为 6 30次 ;有小症状发生者为 80 1次 ;4年内共做BVM法 6 5 5 5次 ,有低血压发生的血液透析次数为 330次 ,有小症状发生者为 4 1 0次。BVM法血液透析中低血压和小症状发生率显著减少 (P <0 .0 5 ) ,而治疗前后血压、体重的改变量两方法间差异无显著性。结论　单用BVM法血液透析可以减少血液透析中常见并发症发生率 ,辅助提高患者对血液透析的耐受性。但并不能依靠它完全避免这些并发症的发生。BVM法血液透析减少血液透析中并发症的机理及其它新的方法仍需继续研究和探索。

The application of continued relative blood volume monitoring during dialysis session

Objectives To study the efficacy of relative blood volume monitoring which biofeedback control the ultrafiltration rate in dialysis session for reducing the intradialysis complications. Methods Thirty dialysis patients were enrolled in the study from Dec. first 2000 to Dec. first 2004. During the 4 years, the patients were treated with common hemodialysis and BVM (blood volume monitoring) dialysis alternately, the total numbers of the dialytic sessions with episodes of hypotension or minor symptoms such as headache, muscular cramps, nausea, or abdominal pain were counted. The pre and post-dialytic blood pressure, the alteration of body weight were noted respectively. Results The 30 patients had undergone 6550 common dialysis sessions in the 4 years, in which 630 dialysis sessions had presented hypotension, 801 dialysis sessions had presented minor symptoms,and 6555 BVM dialysis sessions were undergone in the 4 years, in which 330 dialysis sessions had presented hypotension. Four hundred and ten dialysis sessions had presented minor symptoms.The rates of hypotension and minor episodes occurred in dialysis session were decreased significantly when using the BVM dialysis treatment (P<0.05) without over retention of body fluid. The alteration of body weight between the two kinds of dialysis presents no significant difference. Conclusions Relative blood volume monitoring which biofeedback-control the ultrafiltration speed in dialysis session can help to decrease the rate of episodes of intradialytic hypotension or minor symptoms such as headache, muscular cramps, nausea, or abdominal pain and can help to increase patient's tolerance to the blood dialysis. But BVM dialysis treatment could not prevent all the intradialytic hypotension and minor symptoms from occurring. The mechanism of the benefits of BVM dialysis and other methods for decreasing the rate of episodes of intradialytic complications is still awaiting further study.