CAJ | 학술논문

目的比较二水平阶梯超滤与序贯透析用于血液透析过多水潴留患者临床效果.方法选取2010年1月至2011年9月在我院符合透析间期过多水潴留患者23例,共进行198次透析.二水平阶梯超滤高水平段和序贯透析单超均设置1h,超滤量占总量的1/3,剩余2/3超滤量在余下透析时段完成.比较透析过程的血压、超滤量完成、血浆渗透压、血管通路压力检测及透析过程病情观察等指标.结果采用二水平阶梯超滤出现低血压、肌肉痉挛病例略多于序贯透析,实际完成的超滤量略少于序贯透析,差异均无统计学意义(P均＞0.05).序贯透析单超时肝素量、静脉压、跨膜压高于高水平超滤时段[ (7.48±1.73) mg/h与(6.25±1.36) mg/h、(128.62±10.53)mm Hg与(96.35±11.84)mm Hg、(236.84±23.65)mm Hg与(175.94±24.72) mm Hg,t值分别为5.374、20.166、17.516,P均＜0.01].1h高水平时段超滤平均动脉压(MAP)低于单超时段[(100.48±5.78) mm Hg与(102.54±5.39)mmHg,t =2.571,P＜0.05],MAP差值高于单超时段[(11.46 ±6.53)mm Hg与(9.42±5.46)mm Hg,t=2.385,P＜0.05],血浆渗透压低于单超时段[(311.42±7.36) mOsm/(kg· H2O)与(317.31±6.89)mOsm/(kg· H2O),t=5.774,P＜0.01],但较少出现症状性低血压和其他不良反应.结论两种透析超滤方法皆可用于过多水潴留患者,能够减少超滤并发症,较好地完成超滤目标值.二水平阶梯超滤所具有的透析超滤一体性,更易被临床采用.
목적 비교이수평계제초려여서관투석용우혈액투석과다수저류환자림상효과.방법 선취2010년1월지2011년9월재아원부합투석간기과다수저류환자23례,공진행198차투석.이수평계제초려고수평단화서관투석단초균설치1h,초려량점총량적1/3,잉여2/3초려량재여하투석시단완성.비교투석과정적혈압、초려량완성、혈장삼투압、혈관통로압력검측급투석과정병정관찰등지표.결과 채용이수평계제초려출현저혈압、기육경련병례략다우서관투석,실제완성적초려량략소우서관투석,차이균무통계학의의(P균＞0.05).서관투석단초시간소량、정맥압、과막압고우고수평초려시단[ (7.48±1.73) mg/h여(6.25±1.36) mg/h、(128.62±10.53)mm Hg여(96.35±11.84)mm Hg、(236.84±23.65)mm Hg여(175.94±24.72) mm Hg,t치분별위5.374、20.166、17.516,P균＜0.01].1h고수평시단초려평균동맥압(MAP)저우단초시단[(100.48±5.78) mm Hg여(102.54±5.39)mmHg,t =2.571,P＜0.05],MAP차치고우단초시단[(11.46 ±6.53)mm Hg여(9.42±5.46)mm Hg,t=2.385,P＜0.05],혈장삼투압저우단초시단[(311.42±7.36) mOsm/(kg· H2O)여(317.31±6.89)mOsm/(kg· H2O),t=5.774,P＜0.01],단교소출현증상성저혈압화기타불량반응.결론 량충투석초려방법개가용우과다수저류환자,능구감소초려병발증,교호지완성초려목표치.이수평계제초려소구유적투석초려일체성,경역피림상채용.
Objective To compare the clinical effects between the two-level ladder ultrafiltration and sequential dialysis for hemodialysis patients with excessive water retention.Methods According to our hospital standard,23 patients with water retention during treatment with dialysis from January 2010 to September 2011 were selected.And they conducted a total of 198 dialysis.Both the two-level of high-level segment and sequential ultrafiltration step dialysis were set for 1 hour.Ultrafiltration accounted for one-third of the total,and the remaining two-thirds of the amount of ultrafiltration was completed in the remaining time.The blood pressure,ultrafiltration volume completed,plasma osmotic pressure,detection of vascular access pressure,and other observed indicators during dialysis were compared.Results The occurrence of hypotension and muscle spasms in two-level ladder ultrafiltration was slightly more than that in sequential dialysis,ultrafiltration volume completed actually in two-level ladder ultrafiltration was a little less than sequential dialysis.However,the difference was not statistically significant ( P ＞ 0.05 ).It took more time during sequential dialysis simple ultrafiltration,occasionally dialysis fluid stopped flowing and dialyzer and the trail tube lack of incubation,and some patients could not adapt to it.Amount of heparin( [7.48 ± 1.73 ] mg/h vs[6.25 ± 1.36] mg/h,t =5.374,P ＜ 0.01 ),venous pressure ( [ 128.62 ± 10.53 ] mm Hg vs [ 96.35 ± 11.84 ] mm Hg,t =20.166,P ＜ 0.01 ),trausmembrane pressure( [ 236.84 ± 23.65 ] mm Hg vs [ 175.94 ± 24.72] mm Hg,t =17.516,P ＜ 0.01 ) were significantly higher than those in the high level of ultrafiltration period.Mean arterial pressure ( MAP ) ( [ 100.48 ± 5.78 ] mm Hg vs [ 102.54 ± 5.39 ] mm Hg,t =2.571,P ＜ 0.05 ) and plasma osmotic pressure ( [ 311.42 ± 7.36] mOsm/( kg · H2O ) vs [ 3 1 7.31 ± 6.89 ] mOsm/( kg · H2O ),t =5.774,P ＜ 0.01 ) in high level period were significantly lower than those in the singal ultrafiltration period,and the MAP difference was higher than that in the singal ultrafiltration period ( [ 11.46 ± 6.53 ] mm Hg vs [ 9.42 ± 5.46 ] mm Hg,t =2.385,P ＜ 0.05 ).There is less symptomatic hypotension and other adverse reactions.Conclusion Two dialysis ultrafiltration method can both be used for patients with excessive water retention,they can reduce the ultrafiltraion complications and achieve ultrafiltration targets.Two-level ladder ultrafiltration with dialysis and ultra.filtration unity is more likely to be adopted by the clinic.