钠浓度递增可减轻血液透析期间的低血压及症状。

Sodium ramping reduces hypotension and symptoms during haemodialysis.

作者信息

Tang H L, Wong S H, Chu K H, Lee W, Cheuk A, Tang C M K, Kong I L L, Fung K S, Tsang W K, Chan H W H, Tong K L

机构信息

Division of Nephrology, Department of Medicine and Geriatrics, Princess Margaret Hospital, Laichikok, Hong Kong.

出版信息

Hong Kong Med J. 2006 Feb;12(1):10-4.

PMID:16495583

Abstract

OBJECTIVES

To evaluate the effectiveness of sodium ramping (profiling) in reducing hypotensive episodes and symptoms during haemodialysis.

DESIGN

Prospective study.

SETTING

Regional hospital, Hong Kong.

PATIENTS

Thirteen patients who experienced frequent episodes of hypotension and/or symptoms such as cramps, dizziness, chest pain, nausea, vomiting, and headache during haemodialysis in the preceding 4 weeks.

INTERVENTIONS

Each patient was switched from standard haemodialysis with a constant dialysate sodium concentration of 135 to 140 mmol/L to a ramped sodium haemodialysis for a period of 4 weeks. During this time the dialysate sodium concentration was ramped linearly downwards from 150 mmol/L at the beginning of dialysis to 140 mmol/L at the end of dialysis.

MAIN OUTCOME MEASURES

Intradialytic hypotensive episodes, intradialytic symptoms, nursing interventions, systolic and diastolic blood pressures, and interdialytic weight gain.

RESULTS

A total of 248 haemodialysis sessions undertaken by 13 patients were analysed. Switching from constant sodium haemodialysis to ramped sodium haemodialysis resulted in a significant reduction in the number of intradialytic hypotensive episodes from 5.8 (standard deviation, 6.4) to 2.2 (3.3) [P<0.05], the total number of intradialytic symptoms from 7.1 (3.4) to 0.9 (1.3) [P<0.01], and nursing interventions from 11.3 (6.3) to 1.7 (3.9) [P<0.01]. Post-dialysis systolic and diastolic blood pressures were higher during ramped sodium haemodialysis compared with constant sodium haemodialysis (systolic blood pressure, 139 [standard deviation, 23] vs 133 [22] mm Hg, P<0.001; diastolic blood pressure, 77 [11] vs 74 [13] mm Hg, P<0.01), and there was a trend towards a smaller drop in blood pressure after dialysis. The interdialytic weight gain with sodium ramping haemodialysis was greater compared with constant sodium haemodialysis (3.1 [standard deviation, 1.0] vs 2.7 [1.1] kg, P<0.001).

CONCLUSION

Sodium ramping during haemodialysis effectively reduces hypotensive episodes and intradialytic symptoms. Post-dialysis blood pressure is better maintained. A side-effect of sodium ramping is a greater interdialytic weight gain.

摘要

目的

评估钠浓度渐变（梯度调节）在减少血液透析期间低血压发作及症状方面的有效性。

设计

前瞻性研究。

地点

香港地区医院。

患者

13例在过去4周血液透析期间频繁出现低血压发作和/或伴有痉挛、头晕、胸痛、恶心、呕吐及头痛等症状的患者。

干预措施

每位患者从透析液钠浓度恒定为135至140 mmol/L的标准血液透析转换为钠浓度渐变的血液透析，为期4周。在此期间，透析液钠浓度从透析开始时的150 mmol/L线性下降至透析结束时的140 mmol/L。

主要观察指标

透析期间的低血压发作、透析期间的症状、护理干预措施、收缩压和舒张压以及透析间期体重增加情况。

结果

对13例患者进行的总共248次血液透析治疗进行了分析。从恒定钠浓度血液透析转换为钠浓度渐变血液透析后，透析期间低血压发作次数从5.8次（标准差6.4）显著减少至2.2次（3.3）[P<0.05]，透析期间症状总数从7.1次（3.4）减少至0.9次（1.3）[P<0.01]，护理干预措施从11.3次（6.3）减少至1.7次（3.9）[P<0.01]。与恒定钠浓度血液透析相比，钠浓度渐变血液透析后透析后收缩压和舒张压更高（收缩压，139[标准差23]对133[22]mmHg，P<0.001；舒张压，77[11]对74[13]mmHg，P<0.01），且透析后血压下降幅度有减小趋势。钠浓度渐变血液透析的透析间期体重增加比恒定钠浓度血液透析更大（3.1[标准差1.0]对2.7[1.1]kg，P<0.001）。