摘要目的 观察持续缓慢低效血液透析(SLED)与常规间断性血液透析(IHD)对重症肾功能衰竭患者血液动力学的影响.方法 纳入重症肾功能衰竭患者20例,采用自身对照法分为两组,对照组(A组,n=20)行间断性血液透析4h,观察组(B组,n=20)行持续缓慢低效血液透析6h.治疗全程每小时记录平均动脉压(MAP)和心率(HR),记录一过性低血压发生情况.比较治疗前后两组患者中心静脉压(CVP)、尿素氮(BUN)、血肌酐(Scr)、血白蛋白(ALB)、血钾(K)、β2-微球蛋白(β2-MG)、心钠肽(BNP)水平.结果 持续低效缓慢血液透析与普通血液透析两种治疗低血压的发生率分别为20％和55％,差异有统计学意义(P＜0.05);两组治疗前MAP和HR无显著差别,治疗后30 min两组MAP均显著下降,HR增快,治疗后1和2h观察组MAP值上升,HR下降,与对照组比较差异有统计学意义(P＜0.05).两组治疗前后ALB差异无统计学意义,两种方法治疗后Scr、BUN、K、β2-MG、BNP、CVP下降(P＜0.01),SLED治疗后BUN、β2-MG、CVP、BNP下降,与IHD比较差异有统计学意义(P＜0.05).结论 在血液动力学方面,持续缓慢低效血液透析对重症肾功能衰竭患者的影响比间断性血液透析小,而且心功能改善更明显,毒素清除率更高,临床效果更好.

abstractsObjective To observe the effects of sustained low efficiency hemodialysis and conventional intermittent hemodialysis on hemodynamics in patients with severe renal failure.Methods Twenty patients with severe renal failure were assigned to two groups:the control group (group A,n =20) obtained intermittent hemodialysis for 4 h,and the observation group (group B,n =20) were treated with sustained low efficiency hemodialysis for 6 h.Mean arterial pressure,heart rate and transient hypotension were observed.Before and after the treatment,central venous pressure,blood urea nitrogen,serum creatinine,serum albumin,serum potassium,beta 2-microglobulin and atrial natriuretic peptide were compared bewteen the two groups.Results The sustained low efficiency hemodialysis hypotension and slow hemodialysis treatment in two occurred in 20％ and 55％ respectively(P ＜ 0.05).MAP and HR showed no significant difference between the two groups before the treatment.After the treatment,two groups of 30 min and MAP decreased significantly,increased heart rate,observation group 1,2h map value increased,HR decreased significantly,and the control group (P ＜ 0.05) difference.ALB before and after treatment in two groups were not statistically significant difference statistically significant,SCR,urea nitrogen,potassium,beta 2-MG,BNP,CVP decreased after treatment with beta two methods (P ＜ 0.01),BUN after treatment,the sled,beta 2-MG,CVP,BNP decreased beta,the difference was statistically significant (ischemic heart disease,P ＜ 0.05).Conclusion Sustained low efficiency hemodialysis in patients with severe renal failure than the effect of intermittent hemodialysis is small,and the cardiac function was significantly improved,toxin removal rate is higher,better clinical effects.