可调性透析液温度与盐浓度对血液透析过程中低血压发生的干预评价

目的探讨透析液的温度与盐浓度对血液透析过程中低血压的干预策略及临床疗效。方法选择在中国人民解放军总医院第二附属医院常规接受血液透析时间超过6月,有超过3/4透析次数中发生症状性低血压,同时收缩压下降至少25%和(或)收缩压低于100mmHg(1mmHg=0.133Kpa),需要药物干预的门诊患者4例。每个患者分别接受低温高盐透析、低温标准透析、常温高盐透析、常温标准透析各3次,监测患者的平均动脉压MAP,数据用MicrosoftExcel登记汇总,用SSPS软件进行齐次性检验和方差分析,以P<0.05为差异有显著性意义。结果四组病例透析中、透析后的MAP进行方差分析,各组在P<0.05水平上差异有显著性。采用LSD法对透析中各组MAP进行均值多重比较,常温标准透析在P<0.05水平上与其他3组差异有显著性;采用Tamhane法对透析后各组MAP进行均值多重比较,低温高盐透析在P<0.05水平上与常温高盐透析和常温标准透析差异有显著性。结论低温高盐透析改善患者对超滤的耐受性,有益于避免IDH,显著减少了护理措施和医疗成本。患者对低温高盐透析感知正面积极,是一种简单、有益和经济的措施。

The effect of adjustable dialysate temperature and sodium concentration on intradialytic hypotension occurrence

Objective To explore the strategies of using adjustable dialysate temperatureand sodium concentration to reduce the occurrence of intradialytic hypotension and observe itsclinical effects. Methods Four out-patients in our unit who had received haemodialysis for morethan 6 months shown symptomatic hypotension in more than 3/4 episodes of treatment, with a than 25%reduction and /or lower than 100mmHg of systolic blood pressure needing medication were selectedto participate this experiment. Each patient underwent cool-temp and high-sodium, cool-temp andstandard-sodium, standard -temp and high-sodium, standard-temp and standard-sodium dialysis for 3times respectively, and MAP were monitored during the process. Microsoft Excel was used to enrolland collect the data, SPSS software was used to do Test of Homogeneity of Variance and One-WayANOVA, and statistical significance was defined as P<0.05. Results One-Way ANOVA of the MAP dataduring and after haemodialysis in the 4 cases showed that there were significant differences at thelevel of P<0.05 in each group. Post Hoc Multiple Comparisons of the MAP during haemodialysis ineach group using LSD method showed that there were significant differences at the level of P<0.05 between standard-temp and standard-sodium dialysis group and other three groups. Post HocMultiple Comparisons of the MAP during haemodialysis in each group using Tamhane method showed thatthere were significant differences at the level of P<0.05 between cool-temp and high-sodiumdialysis group and standard-temp and high-sodium, standard-temp and standard-sodium dialysisgroup. Conclusion cool-Temp and high-sodium dialysis improves tolerance for dialysis in hypoten-sive patients and helps increase ultrafiltration while maintaining haemodynamic stability duringand after dialysis. Patients perceptions were positive. The use of cool dialysate is a simple,useful and economical procedure, especially for highly symptomatic patients.