摘要目的:研究血容量反馈控制系统对改善维持性血液透析（maintenance hemodialysis，MHD）患者发生透析中低血压（intradialytic-hypotension，IDH）的作用。方法:该研究采用前瞻性队列研究方法。选取2021年3月至2022年3月浙江大学医学院附属第一医院透析中心反复发生IDH的30例MHD患者，以A-B-A倒返实验设计进行自身对照研究，分别进行4周12次的基线期（A1）常规透析治疗、干预期（B）血容量反馈控制下的透析治疗以及再观察的倒返期（A2）常规透析治疗。统计并比较A1期、B期和A2期中患者平均IDH发生次数、IDH相关不良事件（因IDH并经临床判断需停止脱水且停止时间>10 min或需提前>10 min下机的事件，IDH-related adverse events，IDH-RAE）的发生频率。在共1 080次透析记录中，以年龄、性别以及是否使用血容量反馈控制系统为自变量，以是否发生IDH-RAE为因变量建立Logistic回归模型。结果:本研究纳入的30例MHD患者中，男性14例（46.7%），女性16例（53.3%），年龄63.0（56.5，72.5）岁，中位透析龄84.0（37.2，120.0）个月。30例MHD患者平均IDH发生次数由A1期的1.17（0.83，1.67）次下降至B期的0.33（0.25，0.58）次（ P<0.05）；IDH-RAE的发生频率由A1期的0.29（0.19，0.47）下降至B期的0.17（0，0.25）（ P<0.05）。Logistic回归分析结果显示，使用血容量反馈控制系统可使患者IDH-RAE的发生风险降低53%（ OR=0.47，95% CI 0.34～0.64， P<0.001）。 结论:应用血容量反馈控制系统可以有效减少MHD患者IDH发生的次数，降低IDH-RAE的发生风险。

abstractsObjective:To study the effect of blood volume feedback control system on improving intradialytic-hypotension (IDH) in maintenance hemodialysis (MHD) patients.Methods:It was a prospective cohort study. Thirty MHD patients with recurrent IDH in the Dialysis Center of the First Affiliated Hospital of Zhejiang University School of Medicine from March 2021 to March 2022 were selected. A self-control study was conducted in MHD patients. The patients were treated with routine hemodialysis in both baseline phase (A1) and reversal phase (A2), while with hemodialysis under the blood volume feedback control system in intervention phase (B). Each phase lasted for 4 weeks (12 hemodialysis sessions). The average occurrences of IDH and IDH-related adverse events (IDH-RAE, stopping dehydration for more than 10 minutes or getting off the hemodialysis machine 10 minutes earlier due to IDH) of each patient between phase A1, B, and A2 were calculated and compared. In a total of 1 080 dialysis records, a logistic regression analysis model was established with age, sex and intervention as independent variables and with the occurrence of IDH-RAE as the outcome.Results:A total of 30 eligible patients were included in the study, including 14 males (46.7%) and 16 females (53.3%), aged 63.0 (56.5, 72.5) years old, with a median dialysis age of 84.0 (37.2, 120.0) months. The average times of IDH in 30 MHD patients decreased from 1.17 (0.83, 1.67) in stage A1 (before intervention) to 0.33 (0.25, 0.58) in stage B (after intervention) ( P<0.05). The frequency of IDH-RAE decreased significantly from 0.29 (0.19, 0.47) in stage A1 to 0.17 (0,0.25) in stage B ( P<0.05). Logistic regression analysis results indicated that the use of blood volume feedback control system reduced the risk of IDH-RAE by 53% ( OR=0.47, 95% CI 0.34-0.64, P<0.001). Conclusions:The application of blood volume feedback control system can effectively reduce the occurrences of IDH and the risk of IDH-RAE in MHD patients.