血透中进餐对终末期糖尿病肾病患者血压的影响

目的探讨终末期糖尿病肾病(ESDN)患者血液透析(HD)中进餐时血压的变化与意义。方法将20例ESDN患者1686例次维持性HD,按HD中进餐与否分为:进餐组(A组)及非进餐组(B组),并与20例非ES-DN患者1620例次HD也分为:进餐组(C组)及非进餐组(D组)作对照,比较四组平均动脉压(MAP)变化并结合血糖(BG)水平进行分析。结果低血压发生率:A组(339/843,40.2%)B组(265/843,31.4%),C组(251/810,29.8%)D组(167/810,20.6%),(P0.005),B、C两组差异无显著意义;A组伴低血糖(31例次)者MAP明显高于无低血糖(308例次)者;B组伴低血糖(45例次)者的MAP与无低BG(220例次)者相当。A、B两组中伴低血糖者MAP与BG均呈正相关(P0.001)余各组MAP与BG无相关(P0.05)。结论在HD中进餐可能增加症状性低血压的发生率,尤以ESDN患者为甚。在HD中伴低血糖的ESDN患者更易发生低血压。在透析中进餐,可能预防伴低血糖的ESDN患者者所发生的低血压;对无低血糖反应的ESDN患者所发生的低血压,则尽量避免进餐。

Influence on blood pressure for patients with end stage diabetic nephropathy by dining during hemodialysis

Objective To investigate the change and significance of blood pressure for patients with end stage diabetic nephropathy （ESDN） by dining during hemodialysis. Method 20 patients with ESDN undergoing total 1686 times maintenance hedodialysis were randomly divided into dinner group （A）, no diner group （B） during the courses of hemodialysis,and 20 patients without ESDN undergoing total 1620 times maintenance hemodialysis were divided into diner group C and no diner group D. the change of MAP was observed and compared among the four groups combined with BG level. Result The accident rate of hypertension of group A（ 339/848, 40. 2%） 〉 group B （256/843, 31.4%）, C group （251/810, 29.8%）〉group D（167/810, 20.6%）（P〈0.05）. there was no significant difference between group C and group B. MAP of group A with lower BG accidence （31 cases） were significant higher than that of group A without BG accidence （308 cases）. There was no significant in MAP between 45 cases with lower BG accidence and 220 cases without lower BG accidence. MAP of group A and group B with lower BG accidence was positively related to BG level （P〈0. 001）, and MAP of other group was not related to BG level. Conclusion The dinning during the courses of hemodialysis may increase the accidence rate of symptomatic hypotension, especially for patients with ESDN. Hypertension was more likely to be observed among ESDN patients with lower BG accidence during hemodialysis, and dinning in the courses of hemodialysis may protect ESDN patients with lower BG accidence from hypotension accidence. When hypotension happens, ESDN patients without lower BG should avoid intake.