Hypotension hauv kev lim ntshav yog ib qho teeb meem tshwm sim hauv hemodialysis.Nws tshwm sim sai thiab feem ntau ua rau hemodialysis ua tsis tau zoo, ua rau tsis txaus rau kev lim ntshav, cuam tshuam rau kev ua haujlwm zoo thiab kev lim ntshav zoo, thiab tseem cuam tshuam rau cov neeg mob lub neej nyob rau hauv cov xwm txheej hnyav.
Txhawm rau ntxiv dag zog thiab ua tib zoo saib xyuas kev tiv thaiv thiab kev kho mob ntawm hypotension hauv cov neeg mob ntshav lim ntshav yog qhov tseem ceeb los txhim kho tus nqi ciaj sia thiab lub neej zoo ntawm kev saib xyuas cov neeg mob hemodialysis.

Kev lim ntshav nruab nrab qis ntshav siab yog dab tsi

• Txhais

Hypotension ntawm kev lim ntshav yog txhais tau tias yog qhov poob ntawm cov ntshav siab ntau dua 20mmHg lossis poob qis hauv cov ntshav siab siab dua 10mmHg, raws li 2019 tsab ntawm KDOQI (Asmeskas lub hauv paus rau kab mob raum) luam tawm los ntawm NKF.

• Cov tsos mob

Thaum ntxov muaj peev xwm muaj tsis muaj zog, giddy, perspire, mob plab, xeev siab, ntuav, muaj peev xwm muaj dyspasm, nqaij, amaurosis, angina pectoris raws li kev mob kev loj hlob, tshwm sim nco ntsoov poob txawm, myocardial infarction, ib nrab tus neeg mob tsis muaj tsos mob.

• Qhov tshwm sim

Hypotension hauv kev lim ntshav yog ib qho teeb meem ntawm hemodialysis, tshwj xeeb tshaj yog nyob rau hauv cov neeg laus, ntshav qab zib thiab cov neeg mob uas muaj kab mob plawv, thiab qhov tshwm sim ntawm hypotension hauv kev lim ntshav zoo tib yam yog ntau dua 20%.

• Kev phom sij

1. Kev cuam tshuam rau cov neeg mob lub cev lim dej ib txwm muaj, qee cov neeg mob raug yuam kom tawm ntawm lub tshuab ua ntej, cuam tshuam rau qhov txaus thiab tsis tu ncua ntawm hemodialysis.
2. cuam tshuam rau lub neej kev pab cuam ntawm internal fistula, lub sij hawm ntev hypotension yuav ua rau muaj kev tshwm sim ntawm internal fistula thrombosis, uas ua rau tsis ua hauj lwm ntawm arteriovenous internal fistula.
3. Muaj kev pheej hmoo ntawm kev tuag.Cov kev tshawb fawb pom tau tias 2-xyoo kev tuag ntawm cov neeg mob uas nquag IDH yog siab li 30.7%.

Vim li cas thiaj tsim cov ntshav siab qis hauv kev lim ntshav

• Muaj peev xwm nyob ntawm qhov xwm txheej

1. Ntau dhau ultrafiltration lossis ceev ultrafiltration
2. Kev suav tsis raug ntawm qhov hnyav qhuav lossis tsis tuaj yeem suav tus neeg mob qhov hnyav qhuav raws sijhawm
3. Lub sijhawm lim ntshav tsis txaus hauv ib lub lis piam
4. Sodium concentration ntawm dialysate tsawg

• Vasoconstrictor tsis ua haujlwm

1. Qhov kub thiab txias dialysate siab dhau lawm
2. Noj cov tshuaj ntshav siab ua ntej lim ntshav
3. Pub rau kev lim ntshav
4. Mob ntshav qab zib mob hnyav
5. Endogenous vasodilators
6. Autonomic neuropathy

• Hypocardiac muaj nuj nqi

1. Lub plawv tsis muaj zog
2. Arrhythmia
3. Mob plawv ischemia
4. Pericardial effusion
5. Myocardial infarction

• Lwm yam

1. Ntshav
2. Cov hemolysis
3. Sepsis
4. Dialyzer tshuaj tiv thaiv

Yuav ua li cas tiv thaiv thiab kho dialysis qis ntshav siab

• Tiv thaiv kom tsis txhob muaj cov ntshav ntim kom tsawg

Tsim nyog kev tswj hwm ntawm ultrafiltration, rov ntsuam xyuas cov neeg mob lub hom phiaj (qhuav) qhov hnyav, nce lub sij hawm lim dej txhua lub lim tiam, siv linear, gradient sodium nkhaus hom dialysis.

• Kev tiv thaiv thiab kev kho mob ntawm cov hlab ntsha tsis zoo

Txo qhov kub ntawm dialysate antihypertensive tshuaj txo lossis tso tseg cov tshuaj tsis txhob noj thaum lub sij hawm lim ntshav kom raug anemia rational siv cov tshuaj autonomic paj hlwb.

• Stabilize cardiac tso zis

Kev kho mob ntawm lub plawv cov kab mob organic, ceev faj siv lub plawv muaj cov tshuaj tsis zoo.