中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (11): 612-615.doi: 10.3969/j.issn.1671-4091.2016.11.008

• 临床研究 • 上一篇    下一篇

维持性血液透析患者血压变异性的影响因素分析

王葳,于秀峙,王巍巍,张金元   

  1. 南京军区肾脏病研究所 上海解放军第四五五医院
  • 收稿日期:2016-05-11 修回日期:2016-09-20 出版日期:2016-11-12 发布日期:2016-11-12
  • 通讯作者: 王巍巍 w.vwei@163.com E-mail:451929703@qq.com

Related factors for intradialytic blood pressure variability in hemodialysis patients

  • Received:2016-05-11 Revised:2016-09-20 Online:2016-11-12 Published:2016-11-12

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摘要： 目的探讨维持性血液透析患者(maintenance hemodialysis,MHD)透析过程中血压变异性(blood pressure variability,BPV)的影响因素。方法对我院血液透析中心182 例MHD 患者进行回顾性分析，根据患者收缩压变异系数(systolic blood pressure-coefficient of variation,SBP-CV)将患者分为高SBPV 组(SBP-CV≥9.48)和低SBPV 组(SBP-CV＜9.48)，分析透析过程中BPV 的影响因素。为进一步研究透析间期体质量增长率(interdialysis weight gain rate,IDWG%)水平与透析过程中血压变异性的关系，我们以IDWG%的均值(4.1%)作为节点，将MHD 患者分为高IDWG%组(IDWG%≥4.1%)和低IDWG%组(IDWG%＜4.1%)进行分析。结果与低SBPV 组相比，高SBPV 组女性患者比例更大，脱水量更多，IDWG%更高(性别：χ2=2.133，P=0.048；超滤量：t=2.667，P =0.008；IDWG%：t=2.265，P =0.025)；与高SBPV组相比，低SBPV 组的血清白蛋白(albumin，Alb)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol, LDL-C)水平明显降低(Alb：t=2.416，P =0.017, LDL-C：t=2.317，P =0.022)；以SBP-CV 为因变量，其余因素作为自变量，进行多因素多元逐步回归分析，IDWG%、糖尿病、血白蛋白水平与SBP-CV 呈正相
关(IDWG%：β=0.194，P=0.008；糖尿病：β=0.179，P =0.015；Alb：β=0.166，P=0.023)。在高IDWG%组中，透析龄、血磷水平、甲状旁腺激素(parathyroid hormone，PTH)水平、SBP-CV、舒张压变异系数(diastolic blood pressure-coefficient of variation,DBP-CV)均明显高于低IDWG%组(透析龄：t=2.265，P =0.025, 血磷：t=3.763，P＜0.001；PTH：t=2.707，P =0.007；SBP-CV：t=3.831，P＜0.001；DBP-CV：t=2.087，P =0.038)，而年龄小于低IDWG%组(t=2.696，P= 0.008)；高IDWG%组患者透析过程中收缩压与舒张压的变异程度更大，更易出现透析中低血压。结论血液透析中的血压变化是一个涉及多因素的复杂过程，透
析间期体质量增长率是血压变异性的一个重要独立危险因素。控制透析间期体质量增长率有助改善血压变异性。

关键词: 血液透析, 血压变异性, 透析间期体重增长率

Abstract: Objective To evaluate intradialytic blood pressure variability (BPV) in patients on maintenance hemodialysis (MHD), and to investigate the related factors for BPV during MHD sessions. Methods A total of 182 MHD patients were divided into two groups according to the percentage of BPV (systolic blood pressure coefficient of variation, SBP- CV), high BPV group (SBP-CV ≥9.48) and low BPV group (SBPCV＜9.48). Associated factors for BPV were analyzed. To further study the relationship between inter-dialysis weight gain rate (IDWG%) and BPV, we defined the median IDWG% 4.1% as the cut-off value, and divided the patients into higher IDWG% group and lower IDWG% group. Results More females, more ultrafiltration volume, and higher IDWG% were found in the high BPV group (t=2.133 and P=0.048 for gender; t =2.667 and P =0.008 for ultrafiltration volume; t =2.265, P =0.025 for IDWG%). Lower levels of serum albumin (Alb) and LDL-C were found in the low BPV group (t=2.416 and P=0.017 for Alb; t=2.317 and P=0.022 for LDL-C). Multivariate regression analyses showed that BPV was positively correlated with IDWG%, Alb and diabetes (β=0.194 and P=0.008 for IDWG%; β=0.166 and P =0.023 for Alb; β=0.179 and P=0.015 for diabetes). Dialysis duration, phosphorus and PTH levels, SBP-CV, diastolic blood pressure coefficient of variation (DBP-CV) were significantly higher in the higher IDWG% group than in the lower IDWG% group (t =2.265 and P =0.025 for dialysis duration; t=3.763 and P＜0.001 for phosphorus; t =2.707 and P =0.007 for PTH, t = 3.831 and P＜0.001 for SBP-CV: t =2.087 and P =0.038 for DBP-CV), while age was younger in the higher IDWG% group (t =2.696, P =0.008). Conclusion IDWG% is an independent risk factor for BPV. Younger age, long dialysis duration, high levels of phosphorus and PTH are associated with higher IDWG%.
Control of IDWG% is an important method for the improvement of BPV in MHD patients.

Key words: hemodialysis, variability of blood pressure, interdialysis weight gain