Haemodiafiltration in high-cardiovascular-risk patients.
Haemodiafiltration in high-cardiovascular-risk patients.
复制标题
高心血管风险患者的血液透析滤过。
DOI：
10.1093/oxfordjournals.ndt.a092167
复制
发表时间：
1992
期刊：
影响因子：
--
通讯作者：
C. Mion
中科院分区：
文献类型：
--
作者：
M. Mion;P. Kerr;À. Argilés;B. Canaud;J. Flavier;C. Mion
先生，心血管不稳定是当前透析时间缩短趋势的一个常见问题。因此，心血管不稳定的患者可能无法很好地应对快速液体转移，特别是与短期血液透析相关的液体转移，并且可能表现出症状性低血压[1]。血液透析滤过是一种通常被认为可提供更高心血管稳定性的方法，尽管涉及大量液体转移且可能缩短透析时间 [2, 3] - 因此，我们检查了是否有可能治疗一组患有心血管病理的患者，这些患者传统上在我们的科室中接受 CAPD、短期血液透析，特别是血液透析滤过的治疗。我们评估了他们对治疗的血压反应以及他们达到和维持规定干体重的能力。患者。 8 名患者，平均年龄 62 岁（范围 40-76），是根据已知的心血管疾病选择的，包括记录的冠状动脉疾病 (1)、主动脉瓣假体 (1)、节律紊乱 (2) 和弥漫性血管钙化 (6)。自开始透析以来的平均持续时间为 II±I 年（范围 4-19）。 X线平均心胸指数为0.49±0.02。研究阶段。(1) 使用聚砜毛细管膜（Fresenius HF60 或 HF80，Fresenius AG，Bad Homburg，德国）进行血液透析，每周 9 小时。以600ml/min使用无菌碳酸氢盐透析液（Na 140±2，K.2.0，Ca 1.75 mM）。血流量个体化在300至400ml/min之间。(2)血液透析滤过模式采用与血液透析相同的透析时间、膜、透析液和透析液流量，但此外，每次回输18-20升输注液会造成对流损失；这是通过透析液在线超滤产生的[4]。所有患者均通过前臂瘘管进行透析。分析变量。每次治疗前后脉搏、仰卧血压、平均血压（通过 Dinamap 8103©，克雷泰伊，法国）和体重进行评估。记录治疗期间每小时的体重减轻（超滤率）、脉搏、血压和事件（低血压或痉挛发作）。方案和统计数据。患者最初接受维持性血液透析，后来改为维持性血液透析滤过。研究的第二阶段发生在至少两个月的“适应”之后。对于每个阶段，分析了三个周中课程和三天休息后的三个课程。三届会议的手段最终都得到了运用。使用配对学生 t 检验评估两种技术之间的差异
Sir, Cardiovascular instability is a common problem with the current trend to shorter dialysis. Thus patients with cardiovascular instability may not cope well with the rapid fluid shifts in particular associated with short duration haemodialysis and may manifest symptomatic hypotension [1]. Haemodiafiltration is one method commonly considered as offering greater cardiovascular stability despite the large fluid shifts involved and the potential for short dialysis times [2, 3]-We therefore examined whether it was possible to treat a group of patients with cardiovascular pathology, who traditionally would have been managed in our unit with CAPD, with short-duration haemodialysis, and in particular haemodiafiltration. We assessed their blood pressure responses to the treatment in association with their ability to reach and maintain their prescribed dry weight. Patients. Eight patients, mean age 62 years (range 40-76), were selected on the basis of known cardiovascular disease, including documented coronary artery disease (1), aortic valve prosthesis (1), rhythm disturbances (2), and diffuse vascular calcification (6). The mean duration since commencing dialysis was II±I years (range 4-19). The mean cardiothoracic index on X-ray was 0.49±0.02. Phases under study.(1) Haemodialysis was performed using polysulphone capillary membranes (Fresenius HF60 or HF80, Fresenius AG, Bad Homburg, Germany) for 9 h per week. Sterile bicarbonate dialysate (Na 140±2, K. 2.0, Ca 1.75 mM) was used at 600ml/min. Blood flow was individualized between 300 and 400 ml/min.(2) The haemodiafiltration mode utilized the same dialysis duration, membranes, dialysate, and dialysate flow as for haemodialysis, but in addition there was a convective loss with reinfusion of 18-20 litres of infusate per session; this was produced by on-line ultrafiltration of dialysate [4]. All patients were dialysed via forearm fistulae. Variables analysed. Before and after each session pulse, supine blood pressure, mean blood pressure (via a Dinamap 8103©, Creteil, France), and weight were assessed. Each hour during the sessions loss of weight (UF rate), pulse, blood pressure, and incidents (episodes of hypotension or cramps) were recorded.Protocol and statistics. Patients were initially on maintenance haemodialysis and later changed to maintenance haemodiafiltration. The second phase of the study occurred after at least 2 months of'settling in'. For each phase, three mid-week sessions and three sessions after a 3-day break were analysed. The means of the three sessions were utilized in the final analysis. The differences between the two techniques was assessed using Student's t test for paired