维持性血液透析患者透析中高血压控制临床相关因素分析

【目的】探讨维持性血液透析患者透析中高血压的发生情况和临床措施。【方法】回顾性分析2010年1月-2012年5月在武警某总队医院血液透析中心行维持性血液透析患者发生透析中高血压（intradialytic hypertension,IDH）的临床资料,观察通过改善容量负荷、调整降压药和改变透析液钙离子浓度等个体化治疗措施对IDH患者透析前后及透析中血压变化的影响。【结果】145例MHD患者中有25例（17.2%）发生IDH,其中19例通过加强超滤脱水后,透析前收缩压、透析3 h平均动脉压及透析后的收缩压、舒张压、平均动脉压均较治疗前显著下降（P〈0.05）,IDH的发生率显著减低（P〈0.01）。2例患者出现透析后高钙血症,改用钙离子浓度为1.25 mmol/L的透析液透析后,未再出现透析中高血压。4例患者通过透析前、透析中分别加用钙离子拮抗剂、卡托普利后,降低了透析前后血压。【结论】容量超负荷可能是透析中高血压的重要原因之一,通过增加超滤、控制干体质量,调整透析液钙离子浓度和降压药有助控制IDH的发生。

Analysis on the clinical correlation factors of intradialytic hypertension in maintenance hemodialysis patients

【Objective】To investigate the clinical data of intradialytic hypertension（IDH） and the management of the maintenance hemodialysis（MHD） patients.【Methods】Reviewed the clinical records of 25 MHD patients with intradialytic hypertension in a single blood purification center druing Jan 2010 to May 2012.The treatment methods were included the adjustment of volume load,antihypertensive medications and the concentration of calcium in dialysate.【Results】IDH happened in 25（17.2%） of 145 MHD patients.Systolic blood pressure（SBP） before dialysis,mean arterial blood pressure（MAP） during 3 h IDH,and SBP,diastolic blood pressure（DBP） and MAP after dialysis were descended respectively in 19 patients after intensive ultrafiltration（UF,P 0.05）,with a significantly decreased of IDH incidence（P 0.01）.IDH were controlled by lower the concentration of Ca2 ＋ in dialysate in 2 hypercalcinemia patients after dialysis.BP was controlled in 4 patients treated with calcium ion antagon and captopril.【Conclusions】 For patients with hypertension during maintenance hemodialysis,volume overload maybe the most important factor.It is helpful to control IDH by increasing UF,controlling weight,adjusting the concentration of Ca2＋in dialysate and antihypertensive medications.