Franssen Casper F M, Dasselaar Judith J, Sytsma Paulina, Burgerhof Johannes G M, de Jong Paul E, Huisman Roel M
Dialysis Center Groningen, Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands.
Hemodial Int. 2005 Oct;9(4):383-92. doi: 10.1111/j.1492-7535.2005.01157.x.
Automatic feedback systems have been designed to control relative blood volume changes during hemodialysis (HD) as hypovolemia plays a major role in the development of dialysis hypotension. Of these systems, one is based on the concept of blood volume tracking (BVT). BVT has been shown to improve intra-HD hemodynamic stability. We first questioned whether BVT also improves post-HD blood pressure stability in hypotension-prone patients and second, whether BVT is effective in reducing the post-HD weight as many hypotension-prone patients are overhydrated because of an inability to reach dry weight. After a 3-week period on standard HD, 12 hypotension-prone patients were treated with two consecutive BVT treatment protocols. During the first BVT period of 3 weeks, the post-HD target weight was kept identical compared with the standard HD period (BVT-constant weight; BVT-cw). During the second BVT period of 6 weeks, we gradually tried to lower the post-HD target weight (BVT-reduced weight; BVT-rw). In the last week of each period, we studied intra-HD and 24 hr post-HD blood pressure behavior by ambulatory blood pressure measurement (ABPM). Pre- and post-HD weight did not differ between standard HD and either BVT-cw or BVT-rw. Heart size on a standing pre-dialysis chest X-ray did not change significantly throughout the study. There were less episodes of dialysis hypotension during BVT compared with standard HD (both BVT periods: p<0.01). ABPM data were complete in 10 patients. During the first 16 hr post-HD, systolic blood pressure was significantly higher with BVT in comparison with standard HD (both BVT periods: p<0.05). The use of BVT in hypotension-prone patients is associated with higher systolic blood pressures for as long as 16 hr post-HD. BVT was not effective in reducing the post-HD target weight in this patient group.
由于血容量不足在透析低血压的发生中起主要作用，自动反馈系统已被设计用于控制血液透析（HD）期间的相对血容量变化。在这些系统中，有一种基于血容量追踪（BVT）的概念。BVT已被证明可改善HD期间的血流动力学稳定性。我们首先质疑BVT是否也能改善易发生低血压患者的HD后血压稳定性，其次，BVT是否能有效降低HD后体重，因为许多易发生低血压的患者由于无法达到干体重而处于水合过多状态。在进行3周标准HD后，12名易发生低血压的患者接受了两个连续的BVT治疗方案。在第一个为期3周的BVT期间，HD后的目标体重与标准HD期间保持相同（BVT-恒定体重；BVT-cw）。在第二个为期6周的BVT期间，我们逐渐尝试降低HD后的目标体重（BVT-降低体重；BVT-rw）。在每个阶段的最后一周，我们通过动态血压测量（ABPM）研究HD期间和HD后24小时的血压行为。标准HD与BVT-cw或BVT-rw之间的HD前和HD后体重没有差异。在整个研究过程中，透析前站立位胸部X线片上的心脏大小没有明显变化。与标准HD相比，BVT期间透析低血压发作较少（两个BVT阶段：p<0.01）。10名患者的ABPM数据完整。在HD后最初16小时内，与标准HD相比，BVT时收缩压显著更高（两个BVT阶段：p<0.05）。在易发生低血压的患者中使用BVT与HD后长达16小时的较高收缩压相关。BVT在该患者组中未能有效降低HD后的目标体重。
