Thylén P, Ericsson F, Odar-Cederlöf I, Kjellstrand C M
Department of Internal Medicine, Karolinska Hospital, Stockholm, Sweden.
Int J Artif Organs. 1991 Jan;14(1):18-22.
Hypertension is an important risk factor in hemodialysis patients. Fluid overload and increased peripheral resistance are considered the two main causes. We studied the relation between volume state and blood pressure in 18 hemodialysis patients. Actual total body water (aTBW) was measured as tritium space and "ideal" total body water (iTBW) by an anthropometric method. The difference between aTBW and iTBW was considered a measure of fluid excess or deficit. Twelve patients were overhydrated, 5%-23%. Their predialysis blood pressure was significantly correlated to their degree of fluid excess; systolic BP:r = 0.71, p = 0.03, diastolic BP:r = 0.73, p = 0.02, mean arterial BP:r = 0.76, p = 0.03. Five of these patients had multiple antihypertensive drugs instead of adequate ultrafiltration. Five patients had a fluid deficit of -3 to -13% and hypertension due to vasoconstriction. Four of these were adequately treated with antihypertensive drugs but had exaggerated ultrafiltration. TBW determination with tritium is simple to perform and gives information on the volume state and thereby on the cause of hypertension in hemodialysis patients. Based on this, appropriate treatment can be chosen.
高血压是血液透析患者的一个重要风险因素。液体过载和外周阻力增加被认为是两个主要原因。我们研究了18名血液透析患者的容量状态与血压之间的关系。实际总体水（aTBW）通过氚空间测量，“理想”总体水（iTBW）通过人体测量法测量。aTBW与iTBW之间的差异被视为液体过多或不足的一种度量。12名患者存在液体过多，范围为5%至23%。他们透析前的血压与液体过多程度显著相关；收缩压：r = 0.71，p = 0.03，舒张压：r = 0.73，p = 0.02，平均动脉压：r = 0.76，p = 0.03。这些患者中有5名使用多种抗高血压药物而非进行充分的超滤。5名患者存在-3%至-13%的液体不足，且因血管收缩导致高血压。其中4名患者通过抗高血压药物得到了充分治疗，但超滤过度。用氚测定总体水操作简单，能提供有关容量状态的信息，从而了解血液透析患者高血压的原因。基于此，可以选择合适的治疗方法。
