Blood volume regulation.
Blood volume regulation.
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血量调节。
DOI：
10.1146/annurev.ph.22.030160.002025
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发表时间：
1960
影响因子：
18.2
通讯作者：
J. E. Roberts
中科院分区：
文献类型：
--
作者：
E. Reeve;T. H. Allen;J. E. Roberts
心血管疾病死亡仍然是透析人群死亡的最常见原因。在心血管死亡的危险因素中，低血压已经被几位作者调查过，尽管不是所有的作者都得出结论，低血压本身(没有调整年龄等伴随因素)和糖尿病的存在可以被视为死亡的独立预测因素(Tisler等人，2003；Iseki等人，1997；Port等人，1999)。特别是，低血压的存在以及透析中收缩压和舒张压的下降似乎可以预测透析人群的死亡率(Sohji等人，2004年)。其他一些作者发现，不仅透析前低收缩压，而且高值(J形理论)使患者面临更高的死亡风险(Port et al，1999)。然而，尽管在所用材料的生物相容性、更多的对流和透析液的质量方面，透析技术有了一些改进，但到目前为止，收缩压下降似乎是最常见的透析中并发症，占透析相关症状的30%。但高血压确实是影响透析患者的最常见的慢性并存疾病。透析前高血压不能预防低血压发作，没有血压控制目标也不一定会减少低血压的发生。当需要改善血压控制时，应考虑将改进透析治疗本身作为管理策略的一部分(Davenport等人，2008年)。因此，低血压和高血压是透析必须面对的最具挑战性的并发症。有几种策略可用于预防低血压和高血压，如更长或更频繁的透析方案，扩散-对流疗法，以及评估干体重。由于基础设施或资金限制，并不是所有的方法都可以用于常规实践，而其他一些方法在一定程度上会产生相反的效果，如评估干体重对高血压状态有益，但会导致透析中症状的增加(Davenport等人，2008年)。在当今可用的工具中，生物反馈系统，即那些能够使透析的操作条件适应透析过程中患者状态的动态变化的设备，似乎有望为患者的福祉向前迈进一步(Locatelli等人，2005)在这些设备中，血液控制生物反馈系统(HBS)已经被几个人广泛研究
Cardiovascular death remains the most frequent cause of mortality of dialysis population. Among the risk factor of cardiovascular mortality low blood pressure has been investigated by several authors even though not all the author conclude that low blood pressure per se, not adjusted for concomitant factors like age, and the presence of diabetes can be seen as independent predictor of mortality (Tisler et al., 2003; Iseki et al., 1997; Port et al., 1999). In particular, the presence of low blood pressure and the intradialytic fall in the systolic and diastolic blood pressure seems to predict mortality in the dialysis population (Sohji et al., 2004). Some other authors found that not only low predialysis systolic blood pressure but also high values (J shape theory) expose patients at higher risk of mortality (Port et al, 1999). Nevertheless, the fall in systolic blood pressure seems to be to date the most common intradialytic complication accounting for up to 30 % of dialysis related symptoms, despite the several improvement of dialysis techniques in terms of biocompatibility of the material used, more convection and quality of dialysis fluid. But hypertension is indeed the most frequent chronic co morbidity affecting dialysis patients. Predialysis hypertension does not prevent hypotension episodes and not having targets for blood pressure control will not necessarily reduce its onset. When improved control of blood pressure is desired, modifications to the dialysis treatment itself should be considered as part of the management strategy (Davenport et al., 2008). Hypoas well hypertension are then the most challenging complications which dialysis has to face with. Several strategies are available to prevent hypo and hypertension like longer or more frequent dialysis regimen, diffusive-convective therapies, and assessment of dry body weight. Not all of them can be used in routine practice due to infrastructural or financial constraints while some others give in a certain extent opposite’s effects like assessment of dry body weight beneficial for the hypertensive status, but which can lead to an increase of intradialytic symptoms (Davenport et al., 2008). Among the tools today available, the biofeedback systems, those devices able to adapt the operative condition of dialysis to the dynamic changes of the patients status along the dialysis, seems to be promising for contributing a step forward in the patients well-being (Locatelli et al., 2005) Among these devices the Hemocontrol Biofeedback System (HBS) has been extensively studied by several