血液透析患者中心静脉压与超滤量的关系

摘要

Objective; To study the significance of central venous pressure (CVP) for assessing the volume status and guiding the ultrafiltration volume in patients with maintenance hemodialysis (MHD). Methodology: Thirty five MHD patients with stable general conditions were enrolled this study. Before and after single hemodialysis, the parameters involved CVP, ukrofiltration volume, blood pressure{ BP) , heart rate( HR) ,the incidences of low blood pressure and muscular twitching, the interdialytic weight gain(IDWG) , the morning blood pressure in non-dialysis days, incidence of heart failure, admission rate due to cardio-cerebrovascular diseases, the shifts of cardio-thoracic ratio ( CTR) and so on were observed and recorded by a matched pair design with cross-reference. This procedure had taken 6 month, and the former 3 month as a control group without monitoring CVP and the latter 3 month as an observation group with the CVP supervised. Then all the parameters in the two parts were compared. Results; There were significant differences in incidences of low blood pressure, muscular twitching, inter-dialytic heart failure and the morning blood pressure in non-dialysis days (P < 0. 05), while the CTR and admission rate due to cardio-cerebrovascular diseases did not significantly differ. In a single hemodialysis, the decline of CVP correlated with the rectified ultrafiltration volume( r =0. 598). When CVP declined 1 cmH20, the rectified ultrafiltration volume was 9.89 ± 3.57. It was significantly lower in diabetic nephropathy (DN) than that in the non-DN patients [ (8. 26 ±2. 84) vs (11.5 ±4. 08)ml/kg·cmH20,(P <0.05) ]. Conclusion:The corresponding relationship between of CVP and ultrafiltration is helpful to evaluate the volume status in patients with MHD and to decrease the complications with ultrafiltration.%目的：探讨监测中心静脉压(central venous pressure，CVP)在评价维持性血液透析(maintenancehemodialysis，MHD)患者容量状态及指导超滤量中的作用。方法：选取35例病情稳定的MHD患者，采用前后对照的配对设计，利用6个月时间观察记录单次血液透析(HD)前后CVP、超滤量设定、血压、心率、及低血压、肌肉抽搐发生率，HD间期体重增长、非透析日清晨血压、心力衰竭发生率、因发生心脑血管事件的住院率、心胸比(cardiothoracic ratio，CTR)变化等指标，其中前3个月为对照组，未监测CVP，后3个月为观察组，监测CVP变化，分析监测CVP后各指标有无差异。结果：观察组与对照组在HD中低血压发生率、肌肉抽搐发生率、透析间期心力衰竭发生率、非透析日血压等均具有显著差异(P＜0.05)，监测CVP前后心胸比、因心脑血管事件住院率未见显著差异(P＞0.05)。单次透析过程中，CVP下降值与矫正超滤量呈正相关(r=0.598)，CVP每下降1 cmH2O对应矫正超滤量为(9.89±3.57)ml/(kg·cmH2O)，其中糖尿病肾病患者为(8.26±2.84)ml/(kg·cmH2O)，非糖尿病肾病患者为(11.51±4.08)ml/(kg·cmH2O)，两者具有显著性差异(P＜0.05)。结论：监测CVP有助于MHD患者的容量状态评估和矫正超滤量，达到干体重，减少超滤不当相关并发症。