血液透析中预防超滤所致低血压的临床体会

目的:分析比较在总超滤量不变的前提下,常规血液透析(HD)与调整后采用分段超滤透析,同时配合可调钠使用的低血压发生情况。方法:33例患者分为老年组与非老年组,按HD分时段发生低血压统计分析。将调整不同时段超滤率和透析液钠离子浓度HD与每组常规HD进行对比。结果:两组低血压多发生在3、4 h时段,老年组低血压发生率高于非老年组,调整不同时段超滤率和钠离子浓度后,两组低血压发生明显减少。结论:单位时间内超滤过多过快是导致低血压发生的主要原因。在确定合理超滤总量后,调整不同时段超滤率采用先快后慢配合可调钠先高后低的使用原则,可明显减少低血压发生率。

Experience of preventing hypotension accident during hemodialysis

Objective:To compare the rate of hypotension accident during regular hemodialysis(HD) and hemodialysis by means of time-segmentation ultrafiltration with adjustable natrum when the total ultrafiltration volume remained unchanged.Methods: Thirty-three patients were divided into older agegroup or non-older age-group for analyzing the hypotension accident in each duration of HD.Results:Hypotension accident generaly happened at the interval of 3h and 4h during the timesegmentation ultrafiltration in both groups,but hypotension was seen more frequently in older age-group than the non-olders.However,the frequency of hypotension accident became lower in both groups after setting the ultrafiltration volume to time-interval and the natrum ion concentration.Conclusions:Excessive volume and velocity of ultrafiltration in certain time-interval are responsible for hypotension accidents during HD.The rate of hypotension can be dramatically reduced when adjusting the ultrafiltration volume by the means of "bigger volume following smaller volume" and "higher concentration following lower concentration" for adjustable natrum,and besides,measurable total ultrafiltration volume remains necessary.