中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (03): 167-170.doi: 10.3969/j.issn.1671-4091.2017.03.006

• 临床研究 • 上一篇    下一篇

维持性血液透析患者血压晨峰干预的临床研究

蒲超1,白佳柠1,袁锦1,于江川1,陈永忠1,朱再志1,许志忠1   

  1. 1. 四川省眉山市人民医院肾内科
  • 收稿日期:2016-06-02 修回日期:2017-01-02 出版日期:2017-03-12 发布日期:2017-03-12
  • 通讯作者: 许志忠 xuzhizhong378@163.com E-mail:msgy345@sohu.com

A clinical study about the intervention of morning blood pressure surge in maintenance hemodialysis patients

  • Received:2016-06-02 Revised:2017-01-02 Online:2017-03-12 Published:2017-03-12

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摘要： 目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者血压晨峰(morning blood pressure surge,MBPS)临床干预效果。方法选择260 例MHD 患者作为研究对象，筛选出具有血压晨峰的患者为MBPS 组，给予苯磺酸左旋氨氯地平和替米沙坦睡前口服降压及干预血压晨峰，干预时间为12 周。分别在干预前、后测定患者QT 离散度(QT dispersion，QTd)、左心室质量指数(left ventricular mass index，LVMI)、动脉内膜-中膜厚度(intima-media thickness，IMT)。结果①MBPS 组患者24h 收缩压(systolic blood pressure,SBP)、餐后2h 血糖、三酰甘油和年龄高于非MBPS 组患者(t =4.518，P=0.001；t=15.361，P＜0.001；t =5.338，P=0.000；t=2.472，P=0.013)；尿素清除指数(Kt/V)和血红蛋白则低于非MBPS 组患者(t=4.750，P=0.001；t=3.477，P=0.001)。②治疗后MBPS 组患者24h SBP、夜间平均收缩压(mean diastolic blood pressure at night，nmSBP)较前下降(t=4.518，P=0.001；t=5.964，P=0.001；t=5.964,P=0.001)；MBPS、白昼平均收缩压(mean systolic blood pressure at day，dmSBP)、晨起2h 平均收缩压(mean systolic blood pressure，mSBP)下降更显著(t=7.280，P=0.000；t=8.547, P＜0.001；t =9.002,P＜0.001)。③血压晨峰患者的QTd、LVMI、IMT 明显异常，治疗后QTd、IMT 降低(t=4.873,P=0.001;t =5.004,P＜0.001)。④ 苯磺酸左旋氨氯地平和替米沙坦具有较高谷峰比(trough to peak ratio，T/P)和平滑指数(smoothness index，SI)。结论MHD 患者存在血压晨峰现象。睡前口服苯磺酸左旋氨氯地平和替米沙坦能有效干预血压晨峰。

关键词: 维持性血液透析, 血压晨峰, 平滑指数, 动态血压监测

Abstract: Objective To investigate the intervention of morning blood pressure surge (MBPS) in maintenance hemodialysis (MHD) patients. Methods Ambulatory blood pressure monitoring was done in 260 MHD patients. According to the diagnostic criteria of MBPS, MHD patients with MBPS were selected as the research objects. They took the antihypertensives of levamlodipine besylate and telmisartan before sleep for 12 weeks to interfere with MBPS. Ambulatory blood pressure monitoring was conducted before and after the antihypertenive intervention. QT dispersion (QTd), left ventricular mass index (LVMI) and intima- media thickness (IMT) were also measured. Results ①24h SBP, postprandial 2 hours blood glucose, triglyceride and age of the patients were higher in MBPS group than in non-MBPS group (24h SBP: t=4.518, P=0.001; postprandial 2 hours blood glucose: t=15.361, P=0.000; triglyceride: t =5.338, P=0.000; age: t=2.472, P=0.013); urea clearance index (kt/V) and hemoglobin were lower in MBPS group than in non-MBPS group (Kt/V: t =4.750, P=0.001; Hb: t =3.477, P=0.001). ②In MBPS group after the treatment, 24h SBP, mean systolic blood pressure at night (nmSBP), and mean systolic blood pressure drop rate at night decreased significantly (24h SBP: t=4.518, P=0.001; nmSBP: t=5.964, P=0.001; mSBP drop rate at night: t=5.964, P=0.001); MBPS, mean systolic blood pressure at day (dmSBP), and 2h mSBP in the morning decreased more significantly as compared with those before treatment (MBPS: t=7.280, P=0.000; dmSBP: t=8.547, P=0.000; morning 2h
mSBP: t=9.002, P=0.000); diastolic blood pressure at night (nmDBP) drop rate (t=2.431, P=0.018) and nondipper hypertension rate (26% vs. 12%) decreased after the treatment. ③QTd, LVMI and IMT were abnormal in MHD patients with MBPS; QTd and IMT decreased after treatment (QTd: t=4.873, P=0.001; IMT: t=5.004, P=0.000). ④ Levamlodipine besylate and telmisartan have a higher trough to peak ratio (T/P) and smoothness index (SI). Conclusion MBPS exists in MHD patients; Levamlodipine besylate and telmisartan taken before sleep can effectively interfere with MBPS.

Key words: Maintenance hemodialysis, Morning Blood Pressure Surge, smoothness index, ambulatory blood pressure monitoring