摘要
目的探讨在线血容量监测联合米多君治疗在维持性血液透析低血压病人中的临床疗效。方法选择2015年6月至2016年10月邯郸市中心医院收治的75例长期接受维持性血液透析低血压病人为研究对象,根据随机数字表法分为三组,每组25例。对照组实施在线血容量监测,观察组实施在线血容量监测联合米多君治疗,单用米多君组为单独使用米多君治疗。比较三组病人临床疗效,透析前及透析后平均动脉压和心率变化情况,并记录三组病人透析期间不适主诉、低血压发生率以及脱水量。结果观察组治疗总有效率为92.00%,高于对照组的68.00%和单用米多君组的80%,但差异无统计学意义(χ~2=4.500,P=0.105)。三组平均动脉压和心率水平相比,差异无统计学意义(P>0.05);治疗后,观察组各透析时间点平均动脉压水平均高于对照组及单用米多君组,差异有统计学意义(P<0.05);观察组透析时间2、3 h时间点心率低于对照组及单用米多君组,差异有统计学意义(P<0.05)。三组不适主诉率相比较,差异无统计学意义(χ~2=4.260,P=0.119)。观察组脱水量为(2.34±0.51)L高于对照组脱水量(1.83±0.34)L,两组比较差异有统计学意义(t=4.160,P<0.001),但观察组与单用米多君组脱水量(2.09±0.36)相比,差异无统计学意义(t=2.002,P=0.075)。结论对维持性血液透析低血压病人实施在线血容量监测联合米多君治疗,有利于降低低血压发生率,减少病人平均动脉压和心率变化,提高脱水量,减少病人不适感,有利于提高病人生活质量。
Objective To explore the clinical efficacy of online blood volume monitoring combined with Midodrine for hypotensive patients undergoing maintenance hemodialysis.Methods Seventy-five hypotensive patients who had received long-term maintenance hemodialysis in The Central Hospital of Handan from June 2015 to October 2016 were selected as the research objects,and then according to the random number table method,these patients were assigned into three groups,with 25 cases in each group.The control group was given online blood volume monitoring,while the observation group was given online blood volume monitoring combined with Midodrine for treatment,and the Midodrine group was treated with Midodrine only.The clinical efficacy in the three groups,and changes of arterial pressure and heart rate before and after dialysis were compared,and complaints,incidence of hypotension and amount of dehydration during dialysis in the three groups were recorded.Results The total effective rate of treatment was 92.00% in the observation group,which was higher than 68.00% in the control group and was higher than 80.00% in the Midodrine group,but there was no statistically significant difference between the two groups(χ~2=4.500,P=0.105).There were no statistically significant differences in the mean arterial pressure and heart rate among the three groups(P>0.05).After treatment,the mean arterial pressure at different dialysis time points in the observation group was higher than that in the Midodrine group and the control group,and the difference was statistically significant(P<0.05).The heart rates at 2 h and 3 h of dialysis time points in the observation group were lower than those in the control group and the Midodrine group,and the differences were statistically significant(P<0.05).There was no significant difference in the rate of complaints among the three groups(χ~2=4.260,P=0.119).The amount of dehydration in the observation group was(2.34±0.51) L,which was higher than(1.83±0.34) L of the control group,and there was statistically significant difference between the two groups(t=4.160, P<0.001).There was no significant difference in the amount of dehydration between the observation group [(2.34±0.51) L] and the Midodrine group [(2.09±0.36) L](t=2.002,P=0.075).Conclusions For hypotensive patients undergoing maintenance hemodialysis,online blood volume monitoring combined with Midodrine can help to reduce the incidence of hypotension and the changes in mean arterial pressure and heart rate,increase the amount of dehydration,relieve their discomfort,and improve the quality of life among patients.
引文
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