维持性血液透析患者的血压与透析充分性及相关因素分析

目的观察维持性血液透析(MHD)患者血压与透析充分性及其它相关因素间的关系。方法 56例MHD连续12次记录透析前后血压、体重、超滤量(FV),分别计算收缩压(SBP)、舒张压(DBP)和平均动脉压(MAP)的均值,第0、1、2、3个月透析前后测定血液生化值、甲状旁腺激素(PTH)、血红蛋白(Hb)、红细胞压积(Hct),计算尿素清除指数(Kt/V)、尿素下降率(URR)。结果透析充分组(Kt/V≥1.2、URR≥0.65)MHD患者血压明显低于透析不充分组(Kt/V<1.2、URR<0.65)差异有统计学意义(P<0.05);Hct≥0.22组与Hct<0.22组比较MAP差异有统计学意义(P<0.05);Logistic回归分析显示透析间期体重增加量、体重增加率、透析不充分及血清PTH水平与透析前收缩压密切相关(OR=1.98~3.50,P<0.05)。结论充分透析、减少容量负荷是控制MHD患者高血压的关键,透析不充分、透析间期体重增长过多、高血清甲状旁腺激素水平与透析前收缩压升高有密切关系。

Analysis of blood Pressure, Hemodialysis Adequacy and other Associated Factors in Maintenance Hemodialysis Patients.

Objective To investigate the relationship among blood pressure, dialysis adequacy and other relevant factors in mainte- nance hemodialysis （MHD） patients. Methods 56 MHD patients were involved in this study. Blood pressure before and after dialy- sis, body weight and ultrafiltration volume （UFV） were recorded 12 times consecutively. The average of systolic blood pressure （SBP）, diastolic blood pressure （DBP） and mean arterial blood pressure （MAP） were calculated. Blood biochemistry, parathyroid hormone （PTH）, hemoglobin （Hb） and blood cell hematocrit （Hct） were assayed at 0,1,2,3 months before and after dialysis. Urea clearance index （Kt/V） and urea nitrogen clearance rate （URR） were calculated. Results The incidence of hypertension of dialysis adequate （Kt/V≥ 1.2, URR≥0.65） group was lower than dialysis inadequate （Kt/V 〈 1.2, URR 〈 0.65） group, the difference was statistically significant （ P 〈 0.05） ; MAP difference between the Hct≥ 0.22 group and Hct 〈 0.22 group was statistically signifi- cant （ P 〈 0.05）. Logistic regression analysis showed that weight gain of dialysis interval, weight gain rate of dialysis interval, dialy- sis inadequacy and serum PTH levels were closely related risk factors that affect the pre-dialysis systolic blood pressure（OR = 1.98 3.50, P 〈 0.05）. Conclusions Adequate dialysis and low volume load is the key to control hypertension of MHD patients. Dialysis inadequacy, excessive weight gain of dialysis interval and high senan parathyroid hormone （FH-I） were closely related risk factors for high pre-dialysis systolic blood pressure.