透析低血壓

Dialysis Hypotension

吳孟泰(Men-Tai Wu) ； 楊智超(Chih-Chao Yang) ； 林景坤(King-Kwan Lam) ； 李建德(Chien-Te Lee)

《內科學誌》 22卷5期 (2011/10) Pp. 324-334

https://doi.org/10.6314/JIMT.2011.22(5).04

摘要

透析低血壓可分透析中低血壓和慢性低血壓兩種，發生率分別是25%與5～10%。發生的機制，前者受到透析過程中的心肌受損、血量變化、電解質的變化、透析液溫度、對人工腎臟的免疫反應等所影響；後者則有慢性心血管疾病、自主神經失調、血管對血管加壓物質反應遲鈍、內生性血管舒張物質增加等參與其中。不論是透析中低血壓或慢性低血壓，都伴隨著病人主觀的不適、透析清除率的下降、對心臟、大腦、腸胃道等器官的損傷，甚至死亡率的增加。針對發生低血壓的機制，有不同的預防及治療方式，包括改變透析模式，如：透析液鈉離子濃度調整、脫水率調整、透析液降溫、透析機血容量監測與生物反饋療法；改變病患行為模式，如：避免透析中進食、減少透析間體重的增加、調整乾體重；藥物輔助等。惟有找出並改善潛在的醫療問題，方能減少透析低血壓的發生，進而提昇透析病人的醫療品質。

關鍵字

透析 ； 低血壓

並列摘要

Dialysis hypotension can be divided into intradialytic hypotension and chronic hypotension. The former occurs in around 25% of the hemodialysis population, and the latter is present in approximately 5~10% of patients. Factors that predispose to intradialytic hypotension include intradialytic cardiac injury, blood volume change, electrolytes change, immune reactions to dialysis membranes, etc. Chronic hypotension is mediated by chronic cardiac dysfunction, autonomic dysfunction, reduced pressor response to vasopressor agents, and increased production of vasodilator agents. Dialysis hypotension is accompanied by patient discomforts, declined urea reduction rate, organ damage, and increased mortality. Aiming different pathogenesis, we can adopt different treatment strategies, such as dialysate sodium profiling, ultrafiltration profiling, dialysate cooling, blood volume monitoring and biofeedback, increasing dialysis frequency, hemodiafiltration, avoiding intradialytic feeding, minimizing interdialytic weight gain, adjusting dry weight, etc. Every effort has to be made to resolve this important and multifactorial clinical problem.

並列關鍵字

Dialysis ； Hypotension