本文選題：低溫可調鈉透析 + 常規(guī)透析　； 參考：《廣西醫(yī)科大學》2014年碩士論文

【摘要】：目的：觀察低溫聯(lián)合可調鈉透析模式對頻發(fā)透析中低血壓(IDH)患者的影響。 方法：選取2013年1月至2013年12月于廣西醫(yī)科大學第三附屬醫(yī)院頻發(fā)透析中低血壓的維持性血液透析(MHD)患者12例,用自身前后對照的方式,所有觀察對象先作為對照組,按常規(guī)透析方案行24周的透析,后轉為試驗組,再采用低溫可調鈉透析方案行24周透析,兩組進行對照研究。觀察兩組透析患者的血壓變化情況、透析間期體重增長量(IDWG)及超濾量(UFV)；每月透析前檢測血清白蛋白(ALB)、血紅蛋白(HB)水平以及透析前后血鈉濃度、腎功能指標(BUN,SCr);兩組在治療前及療程結束后空腹查血脂4項(TC,TG,HDL-C,LDL-C);并計算兩組實驗過程中的Kt/V值,比較兩組的差異。 結果：1.兩組透析患者透析前的血壓無明顯差異(P0.05),在透析中及透析后低溫可調鈉透析組收縮壓及舒張壓比常規(guī)透析組升高,同時低溫可調鈉透析組在透析過程中患者低血壓的發(fā)生率為8.33%,常規(guī)透析組低血壓發(fā)生率為29.75%,差異具有統(tǒng)計學意義(P0.01)。2.采用低溫可調鈉透析可減少透析間期體重增長量及提高超濾量,與常規(guī)透析組比較,差異有統(tǒng)計學意義(P0.01)。3.兩種透析方法治療前后血鈉濃度、腎功能指標比較無統(tǒng)計學意義(P0.05)。4.采用低溫可調鈉透析后,Kt/V由(0.90±0.10)L提高到(1.24±0.08)L,血清白蛋白由(30.62±2.50)g/L升至(35.12±2.65)g/L,血紅蛋白由(72.44±11.04)g/L提高到(82.23±8.30)g/L,與常規(guī)透析組相比,差異均具有統(tǒng)計學意義(P0.01)。5.常規(guī)透析及低溫可調鈉透析對尿毒癥患者的血脂均無改善作用,兩種透析方法治療前后的血脂水平(TC,TG, HDL-C,LDL-C)比較無統(tǒng)計學意義(P0.05)。 結論：1.對于維持性血液透析中反復出現(xiàn)透析中低血壓的患者,在治療中采用低溫可調鈉透析可減少透析中低血壓的發(fā)生,有利于超濾脫水,是行之有效的預防透析中低血壓的方法之一。 2.低溫可調鈉透析可以提高透析充分性,從而改善患者的營養(yǎng)狀態(tài)以及貧血狀況,此外透析前后血鈉濃度變化不大,避免了透析間期體重增加過多。
[Abstract]:Objective: to observe the effect of hypothermia combined with adjustable sodium dialysis on patients with moderate hypotension and IDH. Methods: from January 2013 to December 2013, 12 patients with maintenance hemodialysis (MHD) with low blood pressure were selected from the third affiliated Hospital of Guangxi Medical University. The patients were dialyzed for 24 weeks according to the routine dialysate scheme, then changed to the experimental group, and then dialyzed with low temperature and adjustable sodium for 24 weeks. The control study was carried out between the two groups. The changes of blood pressure (BP), weight gain (IDWGD) and ultrafiltration (UFV), serum albumin (Alb), hemoglobin (HBB) levels and serum sodium concentrations before and after dialysis were observed in the two groups before and after dialysis. Kidney function index (BUNG) SCrN, fasting blood lipids were measured before and after treatment in the two groups, and the Kt / V values of the two groups were calculated and the differences between the two groups were compared. The result is 1: 1. There was no significant difference in blood pressure between the two groups before dialysis. The systolic and diastolic blood pressure in the dialysate group with low temperature and adjustable sodium after dialysis was higher than that in the routine dialysis group. At the same time, the incidence of hypotension was 8.33 in the low temperature adjustable sodium dialysis group and 29.75 in the routine dialysis group. The difference was statistically significant. Low temperature and adjustable sodium dialysis can reduce weight gain and increase ultrafiltration in dialysate interval. Compared with conventional dialysis group, the difference is statistically significant (P 0.01). 3. There was no significant difference in serum sodium concentration and renal function between the two dialysis methods before and after treatment (P 0.05. 4). Kt / V was increased from 0.90 鹵0.10g / L to 1.24 鹵0.08g / L, serum albumin was increased from 30.62 鹵2.50g / L to 35.12 鹵2.65g / L, and hemoglobin was increased from 72.44 鹵11.04g / L to 82.23 鹵8.30g / L, compared with routine dialysis group, the difference was statistically significant. Routine dialysis and hypothermic adjustable sodium dialysis had no effect on blood lipids in uremic patients. There was no significant difference in serum lipids levels between the two methods before and after treatment (P 0.05). Conclusion 1. For patients with recurrent hypotension in maintenance hemodialysis, low temperature and adjustable sodium dialysis can reduce the incidence of hypotension in hemodialysis, which is beneficial to ultrafiltration dehydration. It is one of the effective methods to prevent hypotension in dialysis. Low temperature and adjustable sodium dialysis can improve dialysis adequacy, thus improve the nutritional status and anemia status of patients. In addition, there is little change in blood sodium concentration before and after dialysis, which avoids excessive weight gain during dialysis period.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R544.2

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