CAJ | 학술논문

目的：拟观察负钠梯度透析对已处于干体重的血液透析( HD)患者高血压的影响。方法：研究入选16例生物电阻抗法评估已处于干体重的透析高血压患者,透析前血钠浓度高于138 mmol/L。以本透析中心标准透析液( Na+浓度为138 mmol/L)透析1个月作为基线,降低透析液Na+浓度至136 mmol/L透析4个月。期间不改变患者饮食钠摄入量,每月使用生物电阻抗技术调整透析后容量状况始终维持在正常范围并相对稳定,观察对家庭血压( Home BP)和透析间期体重增长(IDWG)等的影响。结果：(1)增加负钠梯度2 mmol/L后,降压药用量无明显变化的情况下,家庭血压从第2个月开始明显下降,4个月后家庭血压收缩压(Home SBP)下降14.6 mmHg(P<0.001)；家庭血压舒张压(Home DBP)下降9.6 mmHg,P=0.003。(2)透析后容量状况正常且无明显变化；透析间期体重增长率从(4.81±1.51)%降至(4.36±1.37%),P=0.047。结论：对于处于干体重的透析高血压患者,负钠梯度透析可能具有独立于容量的降压作用。
목적：의관찰부납제도투석대이처우간체중적혈액투석( HD)환자고혈압적영향。방법：연구입선16례생물전조항법평고이처우간체중적투석고혈압환자,투석전혈납농도고우138 mmol/L。이본투석중심표준투석액( Na+농도위138 mmol/L)투석1개월작위기선,강저투석액Na+농도지136 mmol/L투석4개월。기간불개변환자음식납섭입량,매월사용생물전조항기술조정투석후용량상황시종유지재정상범위병상대은정,관찰대가정혈압( Home BP)화투석간기체중증장(IDWG)등적영향。결과：(1)증가부납제도2 mmol/L후,강압약용량무명현변화적정황하,가정혈압종제2개월개시명현하강,4개월후가정혈압수축압(Home SBP)하강14.6 mmHg(P<0.001)；가정혈압서장압(Home DBP)하강9.6 mmHg,P=0.003。(2)투석후용량상황정상차무명현변화；투석간기체중증장솔종(4.81±1.51)%강지(4.36±1.37%),P=0.047。결론：대우처우간체중적투석고혈압환자,부납제도투석가능구유독립우용량적강압작용。
Objective:To observe the effects of increasing sodium diffusive removal by the negative sodium gradient dialysis on blood pressure in hemodialysis patients on dry weight. Methods:16 hypertensive hemodialysis patients on dry weight were enrolled, whose predialysis plasma sodium levels were higher than 138 mmol/L,After a 1-month period with standard dialysate sodium concen-tration of 138 mmol/L( baseline) ,the patients were followed up for a 4-month period with dialysate sodium set at 136 mmol/L,with-out change in instructions to patients about dietary sodium intake. During the period of study,the dry weight was adjusted under the guidance of bioimpedance spectroscopy,to maintain post-dialysis volume status within normal range. The changes of home blood pres-sure and interdialytic weight gain were recorded. Results:(1) Home blood pressure progressively decreased, attained statistical signif-icance by the end of month 2;there was an average fall of 14. 6 mmHg in home systolic blood pressure and 9. 6mmHg in home dias-tolic blood pressure by the end of month 4. (2) The post-dialysis volume parameters remained constant throughout the study period. Interdialytic weight gain adjusted to the estimated dry weight mildly but significantly decreased ( 4. 81 ±1. 51 )% vs ( 4. 36 ±1. 37)%,p=0. 047). Conclusion:In selected hypertensive hemodialysis patients on dry weight, negative sodium gradient dialysis re-sulted in significant blood pressure decrease. It was most likely due to the volume-independent effect.