在线血容量监测在血液透析患者个体化治疗中的应用

目的通过在线血容量（Bloodvolume，BV）监测血液透析过程中相对血容量（Relativebloodvolume，RBV）变化，探讨其在血液透析（Hemodialysis，HD）相关低血压及高血压中的作用。方法选择同济大学附属东方医院肾内科47例维持性HD患者，根据其血压情况将患者分为正常血压（Normal blood pressure，NBP）组14例、症状性低血压（Dialysis-Symptomatic hypotension，SH）组18例，难治性高血压（Dialysis-refractory hypertension，RH）组15例，应用在线BV监测观察HD中RBV、血压、超滤量（Ultrafiltration volume，UV）、平均动脉压（Meanarterial pressure，MAP）的变化。实验分三阶段进行，第一、二阶段为上述指标观察期，第三阶段为干预调整期。进而比较分析各阶段、各组患者各项指标的变化规律。结果NBP、SH、RH各组的RBV变化差异均存在显著性（P〈0．05），根据SH组不同的RBV变化，分别进行上调干体重或改变超滤方式，SH发生率明显下降（P〈0．05）；对RH组患者加强超滤，其MAP较前显著下降（P〈0．05）。结论不同血压表现的HD患者RBV的变化差异存在显著性，监测HD中RBV变化可以对合理设定HD患者的干体重、减少SH发生、控制RH，提高透析安全性，进而制定个体化透析方案提供重要信息。

The significance of on-line blood volume monitoring in individualized treatment of hemodialysis

Objective To investigate on-line monitoring of relative blood volume （RBV） changes during hemodialysis in the prevention of dialysis-related hypotension and hypertension. Methods Forty-seven mainte- nance hemodialysis patients were assigned to 3 groups according to their blood pressure： Normal blood pressure （NBP） group （n = 14）, symptomatic hypotension （SH） group （n = 18） and refractory hypertension （RH） group （n = 15）. On-line monitoring of RBV, blood pressure, ultrafiltration volume and mean arterial pressure was performed during hemodialysis. The study was divided into 3 stages： Stage 1 and stage 2 were observation period and stage 3 was intervention period. Results RBV change was significantly different among NBP, SH and RH groups （P 〈 0.05）. Based on RBV changes, dry body weight of patients in SH group was up-regulated or ultrafiltration mode was changed, so that the incidence of symptomatic hypotension was significantly decreased （P 〈0.05）. In RH group, up-regulation of ultrafiltration volume resulted in the significant decrease of mean arterial pressure after hemodialysis （P〈 0.05）. Conclusions RBV change was different in hemodialysis patients with different blood pressure. On-line monitoring of RBV is helpful for setting up of an appropriate dry body weight, for the prevention of symptomatic hypotension and refractory hypertension, and for the safety of hemodialysis. It also provides important information for the individualized treatment of hemodialysis.