| Abstract: | 透析中低血壓(Intradialytic hypotension)是血液透析中最常見的併發症。脫水速度過快、自律神經失調、心臟功能不好等皆是造成透析中低血壓的原因之一。雖然有不少方法可治療透析中低血壓，但是仍有部分病人會持續發生透析中低血壓。我們使用Dopamine治療八位持續性透析中低血壓病人。病人在血液透析治療中全程給予Dopamine靜脈注射。透析中最低血壓及透析後血壓有顯著改善。使用Dopamine治療後透析中最低收縮壓(96.75±7.19 vs 118.98±9.03mmHg, P<0.001)，透析中最低平均動脈壓(74.58±4.56 vs 82.83±5.89mmHg, P<0.001)，透析後收縮壓(124.24±11.06 vs 132.55±6.25mmHg, P<0.001)，透析後平均動脈壓(89.06±6.90 vs 94.15±9.03mmHg, P<0.001)，透析後舒張壓(72.20±7.96 vs 76.53±5.93mmHg, P<0.001)皆較使用Dopamine治療前為高，並具統計意義。透析後平均每次透析中低血壓次數由1.06±0.49次降到0.31±0.47次(P<0.001)。平均每次透析需要使用Trendelenburg's position次數由0.79±0.59次降到0.14±0.35次(P<0.001)。平均每次透析需要使用生理鹽水由136.07±54.85ml降到34.51±52.72ml (P<0.001)。平均每次透析需要使用50%葡萄糖由8.0±9.60ml降到2.25±6.16ml (P<0.001)。自覺低血壓症狀如頭暈、噁心、嘔吐、呵欠、暈厥、胸悶、抽筋，除抽筋外，皆有顯著改善。整體自覺症狀改善評估：4位病人覺得顯著改善，2位病人覺得中度改善，2位病人覺得輕度改善。脫水量由2.52±0.25kg增加到2.91±0.26kg(P<0.05)。治療過程中，除一病人有心悸外無不適反應。結論，在血液透析過程當中全程使用Dopamine靜脈注射可有效治療持續性透析中低血壓。
Intradialytic hypotension (IDH) is a common and frustrating complication of hemodialysis. Certain hemodialysis patients persistently manifest this problem. Both patient-specific factors (autonomic insufficiency, cardiac dysfunction) and dialysis treatment-related factors (ultrafiltration, increased core temperature) are thought to have significant causative roles. A variety of maneuvers have been used for the treatment of IHD with variable success. However, there are still a subgroup of patients that suffer from IHD. We report our experience of 8 persistent IDH patients treated with intravenous dopamine infusion during a hemodialysis session. After dopamine was intravenously infused during the entire hemodialysis session, there were uniform improvements in the lowest intradialytic blood pressure, as well as the postdialytic blood pressure. Predialysis blood pressures were similar before and after dopamine therapy. The mean lowest intradialytic SBP (from 96.78±7.19 to 118.98±9.03mmHg, P<0.001) and lowest intradialytic MAP (from 74.58±4.56 to 82.83±5.89mmHg, P<0.001) were significantly better after dopamine therapy compared with before dopamine therapy. The same was true for the postdialysis SBP (from 124.24±11.06 to 132.85±6.25mmHg, P<0.001), MAP (from 89.06±6.90 to 94.15±9.03mmHg, P<0.001) and DBP (from 72.20±7.96 to 76.53±5.93mmHg, P<0.001) after dopamine therapy compared with before dopamine therapy. The mean frequency of hypotension episodes significantly decreased following dopamine treatment (from 1.06±0.49 to 0.31±0.47/session, P<0.001). The mean required Trendelenburg's position decreased from a mean of 0.79 time per dialysis session per patient to a mean of 0.14 time per dialysis session per patient following dopamine therapy (from 0.79±0.59 to 0.14±0.35/session, P<0.001). The mean required saline infusion decreased from 136ml per dialysis session per patient to 34ml per dialysis per patient (from 136.07±54.85 to 34.81±52.72ml, P<0.001). The mean required 50% glucose water infusion decreased from 8.0 to 2.25ml per dialysis session per patient (from 8.0±9.60 to 2.25±6.16ml, P<0.001). Subjective symptoms of IHD improvement were found in all patients (4 marked, 2 moderate, 2 mild). Kt/V values before and after dopamine therapy were similar. The amount of fluid removal following dopamine therapy was higher than that before dopamine therapy to a statistically significant level (from 2.52±0.25 to 2.91±0.26Kg, P<0.05). No significant adverse effects were noted. In summary, dopamine therapy for IDH patients during dialysis session seems to be effective and safe in this small number and short-period study. |
