透析液钙浓度改变对血液透析过程中血压变化的影响

目的 探讨透析液钙浓度变化对血液透析相关性难治性高血压的影响.方法 选取空军总医院肾病科合并难治性高血压的血液透析患者20例,采取自身对照的方法,先后应用钙浓度为1.75mmol/L（dCa2＋1.75）及1.50mmol/L（dCa2＋1.5）的透析液各连续进行15次透析,观察每次透析0、1、2、3h及透析结束时的血压,并分别于第15次透析前后观察一般临床指标及血清总钙（Ca2＋）、磷（P3＋）、钙磷乘积及全段甲状旁腺激素（iPTH）的变化.结果 与dCa2＋1.75比较,采用dCa2＋1.50进行透析,患者的血压降低,尤其在第3h及透析结束后,差异有显著性（P＜0.05或P＜0.01）;血钙、钙磷乘积降低（P＜0.05）,其他指标变化无显著性（P＞0.05）.结论 降低透析液Ca2＋浓度,有助于血液透析相关性难治性高血压的控制.

Calcium concentration in dialysate on blood pressure change during hemodialysis

Objective To investigate the influence of calcium concentration in dialysate on dialysisrelated refractory hypertension in maintenance hemodialysis (HD) patients. Methods Twenty HD patients with refractory hypertension were enrolled in this study. Patients were first used dialysate containing Ca2+ 1.75mmol/ L for 15 times of HD and then that containing Ca2+ 1.5mmol/L for another 15 times of HD. Blood pressure was measured at 0, 1, 2 and 3h during HD and after the HD. Serum calcium, phosphate, intact parathyroid hormone (iPTH) and other clinical parameters were determined before and after the change of calcium concentration in dialysate. Results Blood pressure lowered in patients used Ca2+ 1.5mmol/L in dialysate, especially at 3h during HD and after the HD, as compared with that in patients used Ca2+ 1.75mmol/L in dialysate (P < 0.05 or P < 0. 01). Serum calcium and calcium-phosphate product were also decreased in those used Ca2+ 1.5mmol/L in dialysate (P< 0.01). Conclusion Lower calcium in dialysate may be favorable in control of hemodialysis-related refractory hypertension.