Indiana University School of Medicine and Richard L Roudebush VA Medical Center, Indianapolis, Indiana 46202, USA.
Curr Opin Nephrol Hypertens. 2012 Nov;21(6):593-9. doi: 10.1097/MNH.0b013e3283588f3c.
Intradialytic hypotension (IDH) produces uncomfortable symptoms for the patient and reduces the efficiency of dialysis.
IDH may be an important cause of vascular access thrombosis. Automatic biofeedback-controlled dialysis changes dialysate conductivity and ultrafiltration during dialysis. A number of trials suggest that automatic feedback-controlled dialysis improves IDH in part by improvement in myocardial stunning and preservation of cardiac function. However, the effects of automatic biofeedback dialysis are inconsistent between studies and sample sizes are small. Acetate even in small amounts may trigger IDH especially in predisposed patients. Cool temperature dialysate causes vasoconstriction, activates the sympathetic nervous system, preserves central blood volume, and mitigates IDH. Increasing the treatment time to at least 4 h three times a week and limiting dialysate and dietary sodium intake are effective ways to reduce IDH. Ultrafiltration profiling needs further work, but it appears that removing more fluid during the first hour of dialysis and reducing the rate later on may also reduce IDH.
Adequate prescription and frequency of dialysis treatments, limiting dietary and dialysate sodium, ultrafiltration profiling, automatic biofeedback-controlled dialysis, avoidance of acetate, and cool temperature dialysate may be effective strategies to reduce IDH.
透析中低血压（IDH）会给患者带来不适症状，并降低透析效率。
IDH 可能是血管通路血栓形成的一个重要原因。自动生物反馈控制透析在透析过程中改变透析液的电导率和超滤。许多试验表明，自动反馈控制透析通过改善心肌顿抑和保护心功能部分改善 IDH。然而，自动生物反馈透析的效果在研究之间并不一致，且样本量较小。即使是少量的醋酸盐也可能引发 IDH，尤其是在易患患者中。低温透析液会引起血管收缩，激活交感神经系统，保持中心血容量，减轻 IDH。将治疗时间延长至每周至少 3 次、每次 4 小时，并限制透析液和饮食中的钠摄入量，是减少 IDH 的有效方法。超滤谱需要进一步研究，但似乎在透析的前 1 小时内去除更多的液体，并降低后期的去除速度，也可能减少 IDH。
适当的透析治疗方案和频率、限制饮食和透析液中的钠、超滤谱、自动生物反馈控制透析、避免醋酸盐和低温透析液可能是减少 IDH 的有效策略。
