低温可调钠透析对频发透析中低血压患者的影响

发布时间：2018-06-15 01:02

本文选题：低温可调钠透析 + 常规透析　；参考：《广西医科大学》2014年硕士论文

【摘要】：目的：观察低温联合可调钠透析模式对频发透析中低血压(IDH)患者的影响。方法：选取2013年1月至2013年12月于广西医科大学第三附属医院频发透析中低血压的维持性血液透析(MHD)患者12例,用自身前后对照的方式,所有观察对象先作为对照组,按常规透析方案行24周的透析,后转为试验组,再采用低温可调钠透析方案行24周透析,两组进行对照研究。观察两组透析患者的血压变化情况、透析间期体重增长量(IDWG)及超滤量(UFV)；每月透析前检测血清白蛋白(ALB)、血红蛋白(HB)水平以及透析前后血钠浓度、肾功能指标(BUN,SCr);两组在治疗前及疗程结束后空腹查血脂4项(TC,TG,HDL-C,LDL-C);并计算两组实验过程中的Kt/V值,比较两组的差异。结果：1.两组透析患者透析前的血压无明显差异(P0.05),在透析中及透析后低温可调钠透析组收缩压及舒张压比常规透析组升高,同时低温可调钠透析组在透析过程中患者低血压的发生率为8.33%,常规透析组低血压发生率为29.75%,差异具有统计学意义(P0.01)。2.采用低温可调钠透析可减少透析间期体重增长量及提高超滤量,与常规透析组比较,差异有统计学意义(P0.01)。3.两种透析方法治疗前后血钠浓度、肾功能指标比较无统计学意义(P0.05)。4.采用低温可调钠透析后,Kt/V由(0.90±0.10)L提高到(1.24±0.08)L,血清白蛋白由(30.62±2.50)g/L升至(35.12±2.65)g/L,血红蛋白由(72.44±11.04)g/L提高到(82.23±8.30)g/L,与常规透析组相比,差异均具有统计学意义(P0.01)。5.常规透析及低温可调钠透析对尿毒症患者的血脂均无改善作用,两种透析方法治疗前后的血脂水平(TC,TG, HDL-C,LDL-C)比较无统计学意义(P0.05)。结论：1.对于维持性血液透析中反复出现透析中低血压的患者,在治疗中采用低温可调钠透析可减少透析中低血压的发生,有利于超滤脱水,是行之有效的预防透析中低血压的方法之一。 2.低温可调钠透析可以提高透析充分性,从而改善患者的营养状态以及贫血状况,此外透析前后血钠浓度变化不大,避免了透析间期体重增加过多。
[Abstract]:Objective: to observe the effect of hypothermia combined with adjustable sodium dialysis on patients with moderate hypotension and IDH. Methods: from January 2013 to December 2013, 12 patients with maintenance hemodialysis (MHD) with low blood pressure were selected from the third affiliated Hospital of Guangxi Medical University. The patients were dialyzed for 24 weeks according to the routine dialysate scheme, then changed to the experimental group, and then dialyzed with low temperature and adjustable sodium for 24 weeks. The control study was carried out between the two groups. The changes of blood pressure (BP), weight gain (IDWGD) and ultrafiltration (UFV), serum albumin (Alb), hemoglobin (HBB) levels and serum sodium concentrations before and after dialysis were observed in the two groups before and after dialysis. Kidney function index (BUNG) SCrN, fasting blood lipids were measured before and after treatment in the two groups, and the Kt / V values of the two groups were calculated and the differences between the two groups were compared. The result is 1: 1. There was no significant difference in blood pressure between the two groups before dialysis. The systolic and diastolic blood pressure in the dialysate group with low temperature and adjustable sodium after dialysis was higher than that in the routine dialysis group. At the same time, the incidence of hypotension was 8.33 in the low temperature adjustable sodium dialysis group and 29.75 in the routine dialysis group. The difference was statistically significant. Low temperature and adjustable sodium dialysis can reduce weight gain and increase ultrafiltration in dialysate interval. Compared with conventional dialysis group, the difference is statistically significant (P 0.01). 3. There was no significant difference in serum sodium concentration and renal function between the two dialysis methods before and after treatment (P 0.05. 4). Kt / V was increased from 0.90 卤0.10g / L to 1.24 卤0.08g / L, serum albumin was increased from 30.62 卤2.50g / L to 35.12 卤2.65g / L, and hemoglobin was increased from 72.44 卤11.04g / L to 82.23 卤8.30g / L, compared with routine dialysis group, the difference was statistically significant. Routine dialysis and hypothermic adjustable sodium dialysis had no effect on blood lipids in uremic patients. There was no significant difference in serum lipids levels between the two methods before and after treatment (P 0.05). Conclusion 1. For patients with recurrent hypotension in maintenance hemodialysis, low temperature and adjustable sodium dialysis can reduce the incidence of hypotension in hemodialysis, which is beneficial to ultrafiltration dehydration. It is one of the effective methods to prevent hypotension in dialysis. Low temperature and adjustable sodium dialysis can improve dialysis adequacy, thus improve the nutritional status and anemia status of patients. In addition, there is little change in blood sodium concentration before and after dialysis, which avoids excessive weight gain during dialysis period.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R544.2

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