透析期间低血压
Intradialytic hypotension.
作者信息
Gul Ambreen, Miskulin Dana, Harford Antonia, Zager Philip
机构信息
aDialysis Clinic, Inc., Albuquerque, New Mexico bTufts Medical Center, Boston, Massachusetts cUniversity of New Mexico, Albuquerque, New Mexico, USA.
出版信息
Curr Opin Nephrol Hypertens. 2016 Nov;25(6):545-550. doi: 10.1097/MNH.0000000000000271.
PURPOSE OF REVIEW
This review focuses on recent advances in our understanding of intradialytic hypotension (IDH) and measures that may reduce its frequency.
RECENT FINDINGS
The frequency and severity of IDH predict the risk for adverse clinical outcomes. The highest mortality risks associated with IDH were observed when the intradialytic systolic blood pressure (SBP) nadirs were <90 and <100 mmHg and the predialysis SBP were ≤159 mmHg or ≥160 mmHg, respectively. Interdialytic weight gain (IDWG) ≥3 kg occurs more frequently among patients with IDH. Prolonged and possibly more frequent dialysis, use of biofeedback devices, dialysate cooling and limiting sodium loading are useful measures to reduce the frequency of IDH.
SUMMARY
Frequent IDH is associated with high IDWGs and a poor prognosis. Studies on prolonged dialysis, biofeedback devices and cooled dialysate have yielded promising results. Intradialytic relative blood volume monitoring devices have been investigated in preventing IDH but results are mixed. Administration of a sodium/hydrogen exchange isoform 3 inhibitor increases stool sodium but has not been shown to decrease IDWG. IDH continues to be a significant dialysis complication deserving of further investigation.
综述目的
本综述重点关注我们对透析中低血压（IDH）的最新认识进展以及可能降低其发生率的措施。
最新发现
IDH的发生率和严重程度可预测不良临床结局的风险。当透析中收缩压（SBP）最低点分别<90和<100mmHg且透析前SBP分别≤159mmHg或≥160mmHg时，观察到与IDH相关的最高死亡风险。IDH患者的透析间期体重增加（IDWG）≥3kg更为常见。延长透析时间且可能增加透析频率、使用生物反馈设备、透析液冷却以及限制钠负荷是降低IDH发生率的有效措施。
总结
频繁发生的IDH与高IDWG及不良预后相关。关于延长透析时间、生物反馈设备和冷却透析液的研究已取得了有前景的结果。已对透析中相对血容量监测设备预防IDH进行了研究，但结果不一。给予钠/氢交换异构体3抑制剂可增加粪便钠含量，但尚未显示可降低IDWG。IDH仍然是一种值得进一步研究的重要透析并发症。
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