【作者】 陈萍；

【导师】 许冬梅；

【作者基本信息】 山东大学 ， 肾脏病学， 2011， 硕士

【摘要】 目的：探讨中心静脉压监测在评价维持性血液透析患者容量状态及指导超滤量中的作用。方法：选取36名病情稳定的MHD患者为研究对象,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前后中心静脉压、超滤量设定、血压、心率、及低血压、肌肉抽搐发生率,血液透析间期体重增长、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、心胸比变化等指标,其中前3个月为对照组,未监测中心静脉压,后3个月为观察组,监测中心静脉压变化,分析监测中心静脉压后各指标有无差异。结果：观察组在血液透析中低血压发生率、肌肉抽搐发生率、透析间期心力衰竭发生率、非透析日血压平均值低于对照组,并具有显著性差异(P<0.05),监测中心静脉压前后心胸比、因发生心脑血管事件住院率未见显著性差异(p=0.1,0.15),但观察组心胸比及因心脑血管事件住院率低于观察组。单次透析过程中,中心静脉压下降值与矫正超滤量呈正相关(r=0.587),每下降1cmH2OCVP对应矫正超滤量(ml/kg. cmH2O)为9.89±3.57,其中糖尿病肾病患者为8.26±2.84,非糖尿病肾病患者为11.51±4.08,两者具有显著性差异(p<0.05)。结论：中心静脉压监测可及时反映循环血容量和心功能动态变化,结合CVP评估患者容量状态,对于及时、准确的调整血液透析中的超滤量有指导意义。在留有颈内静脉置管的血液透析患者中(特别是长期卧床不能测量体重的患者)应大力推广。更多还原

【Abstract】 Objective:To study the significance of central venous pressure(CVP) for assessing the volume status and guiding the ultrofiltration volume in maintenance hemodialysis(MHD) patients.Methods:Indicators before and after single hemodialysis of 36 MHD patients in stable condition had been observed and recorded by a matched pair design with cross-reference. And the indicators involved CVP, ultrofiltration 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. 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 indicators in the two parts were compared. Results:There were significant differences in incidences of low blood pressure, muscular twitching, interdialytic heart failure and the 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 ultrofiltration volume (r=0.587). When CVP delined lcm H20, the rectified ultrofiltration volume was 9.89+3.57. It was significantly lower in diabetic nephropathy(DN) patients than in the non-DN patients[(8.26±2.84) vs(11.51±4.08)ml/kg. cmH20, (P<0.05)].Conclusions:Central venous pressure is helpful to the evaluation of volume status in MHD patients, and it has a guiding significance to adjust ultrofiltration volume auurately.更多还原