文档介绍：血液透析相关低血压研究进展血液透析相关低血压研究进展张晓良东南大学肾脏病研究所南京中大医院肾脏科内内容容?血液透析相关低血压( IDH )概念? IDH 病理生理学进展? IDH 的防治措施血液透析相关低血压( 血液透析相关低血压( IDH IDH )概念)概念 BP = CO × TVR 血液透析相关低血压( 血液透析相关低血压( IDH IDH )概念)概念??体位性低血压体位性低血压??放射性晕厥放射性晕厥??体位性心律过速综合征体位性心律过速综合征??植物神经功能紊乱植物神经功能紊乱??多器官萎缩多器官萎缩??透析相关低血压透析相关低血压低血压的临床类型低血压的临床类型 Kidney Int Suppl 2006 血液透析相关低血压( 血液透析相关低血压( IDH IDH )概念)概念??正常血压正常血压/ /高血压高血压————血压下降: 血压下降: SBP SBP 下降下降大于大于 30mmHg 30mmHg 。。–糖尿病、左室肥厚、舒张功能不全、心急梗塞后、冠心病、透析间期体重增长( >3 %)等。??基础低血压:透析前血压基础低血压:透析前血压 SBP <100 SBP <100 ~ ~ 110mmHg 110mmHg ,透析中血压下降,透析中血压下降<30mmHg <30mmHg –发生在 1小时内、 1小时后、透析后持续低血压透析相关低血压的表现形式透析相关低血压的表现形式 Kidney Int Suppl 2006 The European Best Practice Guidelines (EBPG) define intradialytic hypotension (IDH) as both a fall in blood pressure and the occurrence of symptoms needing an intervention . A fall in SBP by at least 20mmHg or a decrease in mean arterial pressure by at least 10mmHg is required to qualify for the diagnosis of hypotension . Nephrol Dial Transplant 2007; 22 (Suppl 2):ii22 – ii44 透析相关低血压透析相关低血压??发生于发生于 10 10 ~ ~ 30 30 %的血液透析中%的血液透析中??导致多种合并症的出现(心梗、脑梗等) 导致多种合并症的出现(心梗、脑梗等) ??增加死亡率增加死亡率??导致透析不充分导致透析不充分 Kidney Int Suppl 2006 透析相关低血压的合并症透析相关低血压的合并症 From the . Renal Data System, USRDS 2006 Annual Data Report 透析相关低血压增加死亡危险透析相关低血压增加死亡危险 SBP, mmHg Predialysis Postdialysis 透析后低血压增加死亡率透析后低血压增加死亡率 Hypotension ? Seizures ? Cerebral infarction ? Cardiac ischemia ? Arrhythmias ? Vascular access thrombosis ? Nausea/vomiting /cramps ? Syncope ? Death Hypertension ? LVH ? CVA ? Cardiomyopathy SBP, mmHg