目的 观察维持性血液透析(maintenance hemodialysis，MHD)患者透析前后血流动力学参数变化，比较血流动力学改善与未改善患者的临床指标，探讨血流动力学监测在MHD患者中的应用价值。 方法 选取北京市顺义区医院肾病中心MHD且病情相对平稳患者为研究对象，根据患者血流动力学状态是否改善分为改善组与未改善组。收集患者一般资料及实验室检查结果；胸阻抗法无创监测血流动力学变化。分析血液透析前后血流动力学指标变化及其与临床指标的关联性。 结果 共纳入41例患者。透析前后心率、心率变异性、心脏指数、胸液传导性、肺毛细血管楔压、系统阻力等指标比较差异有统计学意义(t=0.056、2.932、0.998、0.022、0.637、2.653，P=0.023、0.021、0.015、0.005、0.006、0.030)。27例患者透析后血流动力学状态较透析前改善，改善组患者透析后平均动脉压、每搏系统阻力、收缩压及舒张压较透析前下降，差异有统计学意义(t=0.924、2.136、2.453、0.092，P=0.009、0.013、0.004、0.047)。改善组比未改善组患者总胆固醇水平更低，全段甲状旁腺激素(iPTH)控制更合理，差异有统计学意义(t=4.705、5.327，P=0.036、0.026)。 结论 MHD患者透析前后血流动力学参数有显著变化，透析后血流动力学改善的患者血压更平稳，总胆固醇及iPTH水平控制更好。
Objective To observe the changes of hemodynamic parameters before and after hemodialysis in maintenance hemodialysis (MHD) patients, and to explore the clinical value of hemodynamic monitoring in MHD patients by comparison of clinical indicators between patients with improved and those with unimproved hemodynamics. Methods Patients undergoing stable MHD at the Department of Nephrology, Beijing Shunyi District Hospital were selected as study subjects. General clinical data were collected, venous blood samples were obtained before and after hemodialysis, and non-invasive hemodynamic monitoring using thoracic electrical bioimpedance was performed. Changes in hemodynamic parameters before and after dialysis and their correlations with clinical indicators were analyzed. Results A total of 41 patients were included. ① Significant differences in heart rate, heart rate variability, cardiac index, thoracic fluid conductivity, pulmonary capillary wedge pressure, and systemic vascular resistance were observed before and after hemodialysis (t=0.056, 2.932, 0.998, 0.022, 0.637 and 2.653 respectively; P=0.023, 0.021, 0.015, 0.005, 0.006 and 0.030 respectively). ② In the 27 patients with improved hemodynamic status after dialysis, mean arterial pressure, systemic vascular resistance, systolic blood pressure, and diastolic blood pressure decreased significantly post-dialysis (t=0.924, 2.136, 2.453 and 0.092 respectively; P=0.009, 0.013, 0.004 and 0.047 respectively). ③ In the patients with improved hemodynamic status after dialysis, lower total cholesterol levels and the better control of intact parathyroid hormone (iPTH) were found, as compared those in the unimproved group (t=4.705 and 5.327; P=0.036 and 0.026). Conclusion Hemodynamic parameters undergo significant changes after dialysis in MHD patients. Patients demonstrating improved hemodynamic after dialysis exhibit relatively stable blood pressure profiles and better controls of total cholesterol and iPTH.
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