Andrulli Simeone, Colzani Sara, Mascia Franco, Lucchi Leonardo, Stipo Lucia, Bigi Maria Carla, Crepaldi Monica, Redaelli Bruno, Albertazzi Alberto, Locatelli Francesco
Department of Nephrology and Dialysis, Azienda Ospedaliera A. Manzoni, Lecco, Italy.
Am J Kidney Dis. 2002 Dec;40(6):1244-54. doi: 10.1053/ajkd.2002.36894.
The aim of this multicenter prospective study was to investigate the role of relative blood volume (RBV) reduction on intradialytic hypotension.
One hundred twenty-three patients on chronic hemodialysis therapy were considered a priori normotensive (reference group A), intradialytic hypotension prone (group B), and hypertensive (group C). RBV was continuously monitored, and diastolic and systolic blood pressure (SBP) and heart rate (HR) were measured at 20-minute intervals during three dialysis sessions.
Intradialytic RBV reduction was -13.8% +/- 7.0% and similar in the three groups (P = 0.841). SBP and RBV decreased during dialysis, with a sharp initial decrease (in the first 20 minutes for SBP and the first 40 minutes for RBV), followed by a slower decrease. The lying bradycardic response before dialysis was less in group B than group A (a decrease of 3 +/- 7 versus 9 +/- 9 beats/min; P < 0.001). When symptomatic hypotension occurred, RBV reduction was not significantly different from that recorded at the same time during hypotension-free sessions (-13.9% +/- 6.4% versus -12.7% +/- 5.2%; P = 0.149). Group, baseline plasma-dialysate sodium gradient, RBV line irregularity, and early RBV and HR reduction during dialysis influenced the relative risk for symptomatic hypotension with a sensitivity of 80% versus 30% for RBV alone.
We found no difference in reduction in RBV in the three groups and no critical RBV level for the appearance of symptomatic hypotension. With variables easily available within 40 minutes of dialysis, RBV monitoring increases the prediction of symptomatic hypotension.
这项多中心前瞻性研究的目的是探讨相对血容量（RBV）降低在透析中低血压发生过程中的作用。
123例接受慢性血液透析治疗的患者被预先认定为血压正常（参照组A）、易发生透析中低血压（B组）和高血压（C组）。连续监测RBV，并在三次透析治疗期间每隔20分钟测量舒张压、收缩压（SBP）和心率（HR）。
透析中RBV降低幅度为-13.8%±7.0%，三组相似（P = 0.841）。透析期间SBP和RBV下降，起初下降迅速（SBP在前20分钟，RBV在前40分钟），随后下降变缓。B组透析前卧位心动过缓反应低于A组（分别下降3±7次/分钟和9±9次/分钟；P < 0.001）。出现症状性低血压时，RBV降低幅度与未发生低血压期间同一时间记录的幅度无显著差异（分别为-13.9%±6.4%和-12.7%±5.2%；P = 0.149）。组别、基线血浆-透析液钠梯度、RBV曲线不规则性以及透析期间早期RBV和HR降低影响症状性低血压的相对风险，其预测敏感性为80%，而单独使用RBV时为30%。
我们发现三组的RBV降低幅度无差异，且出现症状性低血压无关键RBV水平。通过透析40分钟内易于获取的变量，RBV监测可提高对症状性低血压的预测能力。
