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血浆容量和液体超负荷在血液透析患者超滤和低血压耐受中的作用。

The role of plasma volume and fluid overload in the tolerance to ultrafiltration and hypotension in hemodialysis patients.

机构信息

Centro de Diagnóstico Ángeles (CEDIASA), Mexico City, México D.F.

出版信息

Ren Fail. 2023 Dec;45(1):2151917. doi: 10.1080/0886022X.2022.2151917.

DOI:10.1080/0886022X.2022.2151917
PMID:36632765
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9848374/
Abstract

INTRODUCTION

Ultrafiltration (UF) in hemodialysis (HD) patients is accompanied by irregular falls in plasma volume (PV) and blood pressure (BP).

METHODS

We obtained in 321 patients (large cohort), body weight (BW), BP, samples of blood to determine hemoglobin (Hb) and hematocrit (Ht), Pre and Post HD. We estimated the % variation of the PV and its effect on the BP. In a small cohort of 38/321 patients, arterial blood was drawn Pre and Post HD and at 2, 48, and 72 h to determined Hb and Ht and % variation of the PV. Bio-impedance spectroscopy (BIS) was performed, in the same times, to estimate: dry weight (DW), total body water (TBW), extracellular water (ECW), Fluid overload (FO) and phase angle (PhA).

RESULTS

We divided our large cohort in two groups. The Hypotensive group with a fall equal or more than 20 mmHg (96/321,30%) and Normotensive group with a drop equal or less than 19 mmHg (225/321,70%). The UF was 2.73 ± 0.72 L in the Hypotensive group and 2.53 ± 0.85 L in the Normotensive group ( < 0.0001). The % PV was -11.7 ± 17.8 in the Hypotensive group and -8.53 ± 10.07 in the Normotensive group ( < 0.0001). The systolic blood pressure (SBP) correlated with the % change of the PV ( = -0.232;  < 0.0001). The FO was contrasted with the % of water removed by UF ( = -0.890;  < 0.0001).

CONCLUSION

The SBP drop was secondary to the fall in the PV after UF. The FO was irregular and modulates in part the fall in the SBP.

摘要

简介

血液透析（HD）患者的超滤（UF）伴随着血浆容量（PV）和血压（BP）的不规则下降。

方法

我们从 321 名患者（大队列）中获得了体重（BW）、BP、血液样本，以确定血红蛋白（Hb）和血细胞比容（Ht），HD 前后。我们估计了 PV 的%变化及其对 BP 的影响。在 38/321 名患者的小队列中，在 HD 前后以及 2、48 和 72 小时从动脉血中抽取血液，以确定 Hb 和 Ht 以及 PV 的%变化。在同一时间进行生物电阻抗谱（BIS）以估计：干重（DW）、总体水量（TBW）、细胞外液（ECW）、体液过多（FO）和相位角（PhA）。

结果

我们将大队列分为两组。低血压组下降等于或超过 20mmHg（96/321，30%）和正常血压组下降等于或小于 19mmHg（225/321，70%）。在低血压组 UF 为 2.73±0.72L，在正常血压组为 2.53±0.85L（ < 0.0001）。PV%在低血压组为-11.7±17.8，在正常血压组为-8.53±10.07（ < 0.0001）。收缩压（SBP）与 PV 的变化率相关（ = -0.232； < 0.0001）。FO 与 UF 去除的水量呈反比（ = -0.890； < 0.0001）。

结论

SBP 下降是 UF 后 PV 下降的继发结果。FO 是不规则的，部分调节 SBP 的下降。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4756/9848374/5401aafc2f24/IRNF_A_2151917_F0006_B.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4756/9848374/4ea20360819d/IRNF_A_2151917_F0001_B.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4756/9848374/040e114328c0/IRNF_A_2151917_F0003_B.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4756/9848374/b02832ae33b5/IRNF_A_2151917_F0004_B.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4756/9848374/00109c4bd597/IRNF_A_2151917_F0005_B.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4756/9848374/5401aafc2f24/IRNF_A_2151917_F0006_B.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4756/9848374/4ea20360819d/IRNF_A_2151917_F0001_B.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4756/9848374/93fa32a39db9/IRNF_A_2151917_F0002_B.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4756/9848374/040e114328c0/IRNF_A_2151917_F0003_B.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4756/9848374/b02832ae33b5/IRNF_A_2151917_F0004_B.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4756/9848374/00109c4bd597/IRNF_A_2151917_F0005_B.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4756/9848374/5401aafc2f24/IRNF_A_2151917_F0006_B.jpg

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