55 巻 (2017) 2 号 p. 84-90
During hemodialysis, blood pressure decreases to a state of hypotension in some patients, and temporary measures to increase blood pressure are given. Typically, fluid replacement, medication, and passive leg raising are used. As each strategy has pros and cons, we attempted to find simple and fast-acting measures. Fifteen healthy men participated in this study. Continuous blood pressure, electrocardiograms, stroke volume, and plethysmograms were obtained at various time intervals. The protocol consisted of 15 min of acclimation in a supine position, resting for 5 min, performance of one of the methods to increase blood pressure for 5 or 15 min, and then resting for 1 min. This protocol was performed repeatedly for different methods in random order. The following methods were selected:passive one-leg-bending exercise (5 min), using a leg massage machine (15 min), applying medical stocking (15 min), and talking (5 min). Systolic blood pressure increased significantly only for talking. Diastolic blood pressure also tended to increase for talking, although not significantly. Further, heart rate increased significantly for talking only. Heart rate increased temporarily for passive one-leg-bending exercises for 5 min. Stroke volume tended to decrease for all the methods but not for control. Total peripheral resistance, which was calculated from blood pressure, stroke volume and HR, increased significantly for using a massage machine at the beginning of massage. Pulse wave amplitude tended to decrease for talking. Overall, talking increased heart rate and consequently increased systolic blood pressure, although none of the methods increased stroke volume. These results identified talking as a feasible and fast-acting method to manage hypotension during dialysis.