北京医学
北京醫學
북경의학
BEIJING MEDICAL JOURNAL
2010年
2期
107-110
,共4页
超声稀释%血液透析%低血压%心脏功能
超聲稀釋%血液透析%低血壓%心髒功能
초성희석%혈액투석%저혈압%심장공능
Ultrasound dilution%Haemodialysis%Hypotension%Cardiac function
目的 监测血液透析期间低血压患者的有效血容量、外周血管阻力和心输出量的变化,探讨低血压患者的血液动力学变化规律.方法 采用超声稀释法对20例维持性血液透析中频繁出现复发性低血压的患者进行透析前后中心血容量(CBV)、心输出量(CO)、心脏指数(CI)、外周血管阻力(PVR)的对比分析;在出现低血压反应后分别给予强心药和高浓度葡萄糖干预治疗并在调整干体重后观察上述各项指标的变化(△变量=治疗后-治疗前).结果 血液透析中患者低血压与△CBV和△CO直接相关(P<0.05),而△PVR变化无显著性差异(P>0.05);强心剂和高浓度葡萄糖干预治疗后△CBV(0.04±0.06 vs.11±0.04,)和△CO(0.33±0.15 vs.0.70±0.16)有显著性差异,P均<0.05.调整干体重前后,透析3h △CO有明显升高(-1.63±0.68vs.-0.91±0.34),P<0.05.结论 血液透析期间低血压与有效血容量、心输出量直接相关,与外周血管阻力、心肌储备功能关系不明显.超声稀释法可简便、非侵入性监测血液透析患者血液动力学改变,为干预性治疗提供依据.
目的 鑑測血液透析期間低血壓患者的有效血容量、外週血管阻力和心輸齣量的變化,探討低血壓患者的血液動力學變化規律.方法 採用超聲稀釋法對20例維持性血液透析中頻繁齣現複髮性低血壓的患者進行透析前後中心血容量(CBV)、心輸齣量(CO)、心髒指數(CI)、外週血管阻力(PVR)的對比分析;在齣現低血壓反應後分彆給予彊心藥和高濃度葡萄糖榦預治療併在調整榦體重後觀察上述各項指標的變化(△變量=治療後-治療前).結果 血液透析中患者低血壓與△CBV和△CO直接相關(P<0.05),而△PVR變化無顯著性差異(P>0.05);彊心劑和高濃度葡萄糖榦預治療後△CBV(0.04±0.06 vs.11±0.04,)和△CO(0.33±0.15 vs.0.70±0.16)有顯著性差異,P均<0.05.調整榦體重前後,透析3h △CO有明顯升高(-1.63±0.68vs.-0.91±0.34),P<0.05.結論 血液透析期間低血壓與有效血容量、心輸齣量直接相關,與外週血管阻力、心肌儲備功能關繫不明顯.超聲稀釋法可簡便、非侵入性鑑測血液透析患者血液動力學改變,為榦預性治療提供依據.
목적 감측혈액투석기간저혈압환자적유효혈용량、외주혈관조력화심수출량적변화,탐토저혈압환자적혈액동역학변화규률.방법 채용초성희석법대20례유지성혈액투석중빈번출현복발성저혈압적환자진행투석전후중심혈용량(CBV)、심수출량(CO)、심장지수(CI)、외주혈관조력(PVR)적대비분석;재출현저혈압반응후분별급여강심약화고농도포도당간예치료병재조정간체중후관찰상술각항지표적변화(△변량=치료후-치료전).결과 혈액투석중환자저혈압여△CBV화△CO직접상관(P<0.05),이△PVR변화무현저성차이(P>0.05);강심제화고농도포도당간예치료후△CBV(0.04±0.06 vs.11±0.04,)화△CO(0.33±0.15 vs.0.70±0.16)유현저성차이,P균<0.05.조정간체중전후,투석3h △CO유명현승고(-1.63±0.68vs.-0.91±0.34),P<0.05.결론 혈액투석기간저혈압여유효혈용량、심수출량직접상관,여외주혈관조력、심기저비공능관계불명현.초성희석법가간편、비침입성감측혈액투석환자혈액동역학개변,위간예성치료제공의거.
Objective To abserve the effective circulating blood volume(CBV),peripheral vascular resistance (PVR)and cardiac output(CO)on dialysis patients with intradialytic hypotension,and to better understand the haemodynamics changes during dialysis in order to improve dialysis quality.Methods The changes of central blood volume,cardiac output,cardiac index(CI)and peripheral vascular resistance before and after haemodialysis were measured by HDO2 Haemodialysis monitor during haemodialysis session.In additon we compare the changes of those parameters when giving high concentrated dextroglucose,metrazol and adjust patients'dry weight respectively.Results the decisive factor of intradialytic hypotension were changes of CBV and CO(P<0.05),but PVR had no significant difference(P>0.05).When compared the change between high concentration dextroglucose and metrazol,the former could increase CBV and CO significantly,and cause significant difference in △CBV(0.04±0.06 vs.0.11±0.04,P<0.05)and △CO(0.33±0.15 vs.0.70±0.16,P<0.05).△CO had significant changes(-1.63±0.68 vs.-0.91±0.34,P<0.05)at haemodialysis 3 hour after adjust dry weight.Conclusions The decisive reasons of intradialytic hypotension are reduction of effective circulating blood volume and cardiac output,but not PVR and myocardial reserve.Ultrasound dilution is a simple,non-invasive method for monitoring cardiac function during haemodialysis session and could provide guidance for intervening treatment.
