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血液透析中症状性低血压的影响因素分析

2015-01-25 01:00 【关键词】 肾透析
　　【摘要】 目的 分析不同年龄组血液透析中症状性低血压的发生率及其与超滤量（UFV）、超滤率（UFR）、单位体重超滤量（UFV/W）和透析中不同时段的关系。方法 将35例维持性血液透析（HD）患者分为老年组和非老年组，分别统计其合并症和症状性低血压发生率及各时段症状性低血压数，并与UFV、UFR、UFV/W进行相关分析。结果 症状性低血压发生率老年组为21.1%，明显高于非老年组的14.9%，老年组低血压发生率与UFV、UFR相关系数分别为r=0.962，r=0.958。超滤量＞3L、超滤率＞750ml/h时低血压发生率分别为29.9%和32.9%以上，非老年组低血压发生率与UFV、UFR相关系数分别为r=0.897，r=0.918。超滤量＞4L、超滤率＞1000ml/h时低血压发生率在26.8%和39.6%以上。两组在HD第3h、4h时段低血压例数明显高于HD开始1h、2h时段。结论 UFV、UFR过大是症状性低血压的关键，特别是超滤量＞3~4L，超滤率＞750~1000ml/h低血压发生率更高。
　　【关键词】 肾透析；低血压；超滤
　　【Abstract】 Objective To analyze the relationship between the incidence of symptomatic hypotension and ultrafiltration volume （UFV）,ultrafiltration rate （UFR）,UFV per weight （UFV/W） and the different periods during the hematodialysis in different age.Methods 35 cases of maintenance hemodialysis were divided into the old age group or non-old age group.The complications,symptomatic hypotension cases and incidence were observed and the relationships between them and UFV,UFR and UFV/W were analyzed.Results The incidence of symptomatic hypotension in the old age group was 21.1%,which was higher than that in the non- old age group（14.9%） obviously.The coefficient correlation between the incidence of symptomatic hypotension and UFV,UFR in the old age group were 0.962 and 0.958 respectively.The incidences of symptomatic hypotension were 29.9% and 32.9% respectively when UFV was over 3L and UFR was over 750ml/hr.The coefficient correlation between the incidence of symptomatic hypotension and UFV,UFR in the non-old age group were 0.897 and 0.918 respectively.The incidences of symptomatic hypotension were 26.8% and 39.6% respectively when UFV was over 4L and UFR was over 1000ml/hr.The frequency of symptomatic hypotension during the third and fourth period in two groups was obviously increased than the first and second period during maintenance hemodialysis.Conclusion It is the key cause of symptomatic hypotension that UFV and UFR are excess,especially UFV is over 3~4L and UFR over 750~1000ml/hr. 中国大学排名
　　【Key words】 renal dialysis;hypotension;ultrafiltration
　　低血压是血液透析中最常见的并发症，而超滤量过多是产生症状性低血压主要原因，为了探讨不同年龄症状性低血压与超滤量的关系，确立安全合适的超滤量和超滤速度，现对我院35例3453例次血液透析资料分析如下。
　　1 资料与方法
　　1.1 一般资料 所有病例均为稳定的维持性血液透析病人，其中高血压肾病10例，糖尿病肾病7例，多囊肾2例，慢性肾小球肾炎13例，狼疮性肾炎1例，梗阻性肾病2例。按年龄分为两组：老年组为60岁以上的患者14例，男9例，女5例，平均年龄（70.7±9.3）岁；非老年组为60岁以下的患者21例，男12例，女9例，平均年龄（38.6±5.2）岁。
　　1.2 血液透析方法 均采用德国产Fressenius 4008 B血液透析机、聚砜膜透析器、碳酸氢盐透析液，透析液流量500ml/min，血流量180~250ml/min，透析液温度为37℃，透析液钠浓度为138~145mmol/L，透析次数为2~5天/次，每次4.0~5.0h。根据患者干体重及透析间期增加的体重确定超滤量。