摘要
目的:比较枸橼酸碳酸氢盐透析液与普通碳酸氢盐透析液治疗维持性血液透析患者透析中血压的影响。方法:20例患者随机分为两组,各10例,分别使用枸橼酸碳酸氢盐透析液和普通碳酸氢盐透析液进行透析,第一组患者使用普通碳酸氢盐透析液治疗4周后切换为枸橼酸碳酸氢盐透析液治疗4周。第二组患者直接切换为枸橼酸碳酸氢盐透析液治疗4周后再次切换成普通碳酸氢盐透析液治疗4周。记录透析前后及透析过程中的实验室数据进行统计分析。结果:(1)使用枸橼酸碳酸氢盐透析液的患者透析过程中患者的平均收缩压明显低于普通碳酸氢盐透析液透析时(P<0.01),平均动脉压(MAP)较普通碳酸氢盐透析液透析时降低(P<0.05);枸橼酸碳酸氢盐透析液透析时患者透析中高血压的发生率为3.3%,明显低于使用普通碳酸氢盐透析液透析时(20%,P<0.01)。(2)使用不同透析液透析时患者透析前血清总钙离子与离子钙水平无统计学差异,枸橼酸碳酸氢盐透析液透析时患者透析后血清总钙离子和离子钙水平明显著低于普通碳酸氢盐透析液透析时(P<0.01)。普通碳酸氢盐透析液透析时患者透后血清总钙离子及离子钙水平较透前显著升高(P<0.01),使用枸橼酸碳酸氢盐透析时患者仅出现透后血清离子钙水平下降(P<0.01),而透析前、后血清总钙离子水平无明显改变。(3)不同透析液透析前、后BUN均无统计学差异。虽然枸橼酸碳酸氢盐透析液透析时患者尿素清除指数(Kt/V)要略高于普通碳酸氢盐透析液透析时,但两者之间无统计学差异。两组患者均未出现严重的低血压、低钙血症及抽搐等不良反应。结论:应用枸橼酸碳酸氢盐透析液治疗的患者透析中血压的控制明显优于普通碳酸氢盐透析液。其血压控制佳、高血压发生率低,无严重低血压、抽搐以及碱中毒等不良反应。透析后离子钙浓度减低,但并未发生明显低钙血症。证实了其在临床应用的有效性和安全性。
Objective：To compare the antihypertensive effect of citrate-based dialysate versus regular dialysate in bicarbonate hemodialysis. Methodology： In a crossover randomized design, twenty dialysis patients with hypertension during dialysis underwent two cycles of twelve successive hemodialysis sessions each with a regular bicarbonate and citrate bicarbonate dialysate. At the last three sessions of each cycle, hemodynamic parameters （systolic blood pressure [ SBP], diastolic blood pressure [ DBP], mean arterial pressure [ MAP], heart rate） were measured every hour during dialysis. At the twelfth session of each cycle, Ca level （ iCa, Serum total calcium）, acid-base status （ pH, HCO3- ） and dialysis efficient were assessed using standard biochemical marker. Results： （ 1 ） The patients receiving the citrate dialysate had significantly lower SBP, post-dialysis DBP and incidence of intradialysis hypertension, MAP was also lower than receiving regular bicarbonate dialysate. （2）When patients were treated with citrate dialysis, post-dialysis iCa level was significantly lower than pre-dialysis, but the total calcium concentration was not decreased. The patients receiving the regular dialysate had significantly higher post - dialysis iCa level and total calcium concentration. （ 3 ） The use of citrate was associated with an increased Kt/V, but there were no statistical differences. No patients developed severe hypotension, hypoealcemia, seizures and other side effect. Conclusion： The positive impact on dialysis efficiency, BP and the safety, together indicated that citrate dialysate can significantly contribute to the imporvement hamodialysis in selected patients.
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
北大核心
2010年第5期424-429,共6页
Chinese Journal of Nephrology,Dialysis & Transplantation
