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目的探讨低温透析对透析充分性、稳定性及透析过程中病人主观感觉的影响。方法选择在我院规律维持性血液透析20例,其中在既往透析过程中曾出现低血压事件10例(低血压组),在既往透析过程中及透析后均未出现过低血压事件10例(对照组),入选病例均排除血管通路再循环以及其他影响血流动力学变化的外部因素,均进行3次标准透析液温度透析(37℃)后再进行3次低温透析(36℃),其他透析参数保持不变,对先后是否使用低温透析的两组病人进行尿素氮清除率和透析稳定性的评估。结果低血压组中降低透析液温度能增加单位时间超滤量(P<0.05)。两组病例中低温透析对尿素氮清除率无明显影响(P>0.05);使用低温透析后和透析过程中平均动脉压均显著增高(P<0.05)。在低温透析过程中低血压组心率明显减低(P<0.05),而正常血压组平均心率有减低趋势,但无统计学显著性差异。全部病例共观察到5次症状性低血压事件均发生在低血压组。问卷调查,80%病人对低温透析的主观感觉有明显改善。结论低温透析增强低血压病人透析耐受性、增加单位时间超滤量,从而保持透析过程稳定性。病人主观反应是积极的,这对维持性血液透析病人生活质量均有积极的影响。
Objective To investigate the effect of hypothermic dialysis on dialysis adequacy, stability and patient subjective perception during dialysis. Methods In our hospital, regular maintenance hemodialysis in 20 cases, including in the process of previous dialysis had occurred in 10 cases of hypotension (hypotension group), dialysis in the previous dialysis and no hypotension occurred in 10 cases ( Control group). All the selected cases excluded the recirculation of vascular access and other external factors that influence the hemodynamic changes. Three times of dialysis dialysis (37 ℃) followed by three times of low temperature dialysis (36 ℃) and other The dialysis parameters remained unchanged, and urea nitrogen clearance and dialysis stability were assessed in two groups of patients who used cryogenic dialysis sequentially. Results Lowering dialysate temperature in hypotension group increased ultrafiltration volume per unit time (P <0.05). Low temperature dialysis in both groups had no significant effect on urea nitrogen clearance (P> 0.05). Mean arterial pressure increased significantly after dialysis (P <0.05). Heart rate was significantly lower in hypotension group during hypothermic dialysis (P <0.05), while mean heart rate in normotensive group was decreased, but there was no significant difference. In all cases, five symptomatic hypotensive events were observed in the hypotension group. Questionnaire, 80% of patients on the subjective feeling of low temperature dialysis improved significantly. Conclusion Low-temperature dialysis enhances the dialysis tolerance of patients with hypotension, increases the ultrafiltration volume per unit time, and thus maintains the stability of dialysis process. The patient’s subjective response is positive, which has a positive impact on the quality of life of maintenance hemodialysis patients.