摘要
目的观察环磷腺苷葡胺(MAC)联合低温可调钠透析(LSHD)治疗透析中低血压(IDH)的临床疗效。方法选取2015年6—12月徐州医科大学附属医院和徐州医科大学附属第三医院血液净化中心符合纳入标准的复发性IDH患者28例为研究对象。患者先后采用3种方法[常规血液透析(CHD)、LSHD、MAC联合LSHD(M-LSHD)]进行治疗,各8周,每周3次。记录3种治疗方法治疗过程中患者血压的变化和低血压发生率,检测每种治疗方法最后1次透析前与透析后电解质(K^+、Na^+、Ca^(2+))、尿素氮、血肌酐、N末端前体B型钠尿肽(NT-pro BNP),观察不良反应发生情况。结果3种治疗方法患者透析前收缩压、舒张压比较,差异无统计学意义(P>0.05);M-LSHD治疗患者透析中最低收缩压、舒张压高于CHD、LSHD,低血压发生率低于CHD、LSHD(P<0.05)。3种治疗方法最后1次透析前、后K^+、Na^+、Ca^(2+)、尿素氮、血肌酐比较,差异无统计学意义(P>0.05);M-LSHD透析前、后NT-pro BNP均低于CHD、LSHD(P<0.05)。患者均未出现因低温引起的畏寒、寒战等不耐受现象;MCA静脉注射未见心悸、头晕等药物不良反应发生。结论M-LSHD通过改善IDH患者的心功能,可明显减少IDH的发生,无明显不良反应,有临床推广价值。
Objective To investigate the clinical efficacy of meglumine adenosine cyclophosphate（MAC）combined with low temperature adjustable sodium hemodialysis（LSHD）for intradialytic hypotension（IDH）.Methods We enrolled28 patients with recurrent IDH who were admitted to the Blood Purification Center,Affiliated Hospital of Xuzhou Medical University and the Third Affiliated Hospital of Xuzhou Medical University from June to December 2015 and who met the inclusion criteria.All patients underwent either conventional hemodialysis（CHD）,LSHD,or MAC combined with LSHD（M-LSHD）three times a week for 8 weeks,respectively.Changes in blood pressure and the incidence of hypotension were recorded during hemodialysis.Electrolyte（K＋,Na＋,Ca2＋）,serum urea nitrogen,serum creatinine,and N-terminal pro-brain natriuretic peptide（NT-pro BNP）levels were also measured,and adverse effects were observed before and after the final hemodialysis for each treatment.Results There was no significant difference in systolic or diastolic blood pressure prior to hemodialysis among the three treatments（P〈0.05）.The lowest systolic and diastolic blood pressures during hemodialysis were significantly greater and the incidence of hypotension was significantly lower in patients undergoing M-LSHD compared with CHD or LSHD（P〈0.05）.There were no significant differences in serum K＋,Na＋,Ca2＋,urea nitrogen,or creatinine levels between before and after the final hemodialysis for each treatment（P〈0.05）,but NT-pro BNP levels were significantly lower in patients undergoing M-LSHD compared with the other procedures both before and after hemodialysis（P〈0.05）.In addition,no patients showed intoleranceto low temperature,such as by chilling or shivering,and no palpitation or dizziness occurred following intravenous injection of MCA.Conclusion M-LSHD may reduce the incidence of IDH by improving cardiac function in hemodialysis patients,with no apparent adverse reactions.These results have important clinical implications.
作者
濮红梅
冯锦红
刘秉成
徐静
PU Hong-mei;FENG Jin-hong;LIU Bing-cheng;XU Jing(Department of Nephrology,the Third Affiliated Hospital of Xuzhou Medical University,Xuzhou 221003,China;Department of Nephrology,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221006,China)
出处
《中国全科医学》
CAS
北大核心
2018年第15期1805-1808,共4页
Chinese General Practice
关键词
低血压
血液透析液
强心药
Hypotension
Hemodialysis solutions
Cardiotonic agent
