Saxena Anita, Sharma R K, Gupta Amit, John Manns Manohar
Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Saudi J Kidney Dis Transpl. 2015 Sep;26(5):896-905. doi: 10.4103/1319-2442.164569.
Intradialytic hypotension (IDH) is a life-threatening condition. We evaluated the feasibility of blood volume monitoring (BVM) and blood temperature monitoring (BTM) in preventing IDH in patients prone to the same. Fourteen hemodynamically unstable end-stage renal disease patients who were prone to IDH and unable to achieve dry weight were given BVM treatment twice weekly for two weeks. Forty patients who were not on BVM treatment served as controls. Patients were anemic, had low serum albumin (3.4 ± 0.43 g/dL) and fluid overload and were edematous. Of the 40 patients in the control group, 18 patients experienced IDH and dialysis had to be terminated. The incidence of IDH was 5% in the control group. In the BVM group, the total volume of fluid removed during hemodialysis was between 2.0 and 4.5 L (mean 3.2 L). By the end of dialysis, the hemo-concentration increased by 34.8%. With use of BVM and BTM, the blood pressure did not drop below 120/80 mm Hg, the dialysis sessions were uneventful and none of the patients suffered symptoms of hypotension. There was a difference of 3 kg between weight achieved and dry weight of the patient, although there was a 14.2% reduction in extracellular water (ECW), 14.5% in plasma fluid and 14.5% decrease in interstitial fluid. Blood volume significantly correlated with post-dialysis intracellular water (ICW) (r = 0.722, P = 0.008) and ECW/ICW ratio (r = 0.698, P = 0.012). There was a significant correlation between systolic blood pressure and ECW (r = 0.615, P = 0.033). Diastolic blood pressure significantly correlated with post-dialysis ECW (r = 0.690, P = 0.008), plasma fluid post-dialysis (r = 0.632, P = 0.027) and interstitial fluid (r = 0.604, P = 0.038). The ECW/ICW ratio was high (1.13 ± 0.48; control 0.74), implying overhydration and expanded extracellular fluid. BVM should be included in the dialysis protocol where patient compliance to maintenance hemodialysis is poor and patients are constantly in volume overload.
透析中低血压（IDH）是一种危及生命的状况。我们评估了血容量监测（BVM）和血温监测（BTM）在预防易患IDH患者发生IDH方面的可行性。14例血流动力学不稳定的终末期肾病患者易患IDH且无法达到干体重，每周接受两次BVM治疗，持续两周。40例未接受BVM治疗的患者作为对照。患者均有贫血、血清白蛋白水平低（3.4±0.43g/dL）、液体超负荷且有水肿。对照组40例患者中，18例发生IDH，透析不得不终止。对照组IDH发生率为5%。在BVM组，血液透析期间清除的液体总量在2.0至4.5L之间（平均3.2L）。透析结束时，血液浓缩增加了34.8%。使用BVM和BTM后，血压未降至120/80mmHg以下，透析过程顺利，无患者出现低血压症状。患者达到的体重与干体重相差3kg，尽管细胞外液（ECW）减少了14.2%，血浆液体减少了14.5%，间质液减少了14.5%。血容量与透析后细胞内水（ICW）显著相关（r=0.722，P=0.008）以及ECW/ICW比值（r=0.698，P=0.012）。收缩压与ECW显著相关（r=0.615，P=0.033）。舒张压与透析后ECW显著相关（r=0.690，P=0.008）、透析后血浆液体（r=0.632，P=0.027）和间质液（r=0.604，P=0.038）。ECW/ICW比值较高（1.13±0.48；对照组为0.74），提示存在水合过度和细胞外液增多。在维持性血液透析患者依从性差且患者持续存在容量超负荷的情况下，应将BVM纳入透析方案。
