中国血液净化

中国血液净化 ›› 2014, Vol. 13 ›› Issue (07): 502-505.doi: 10.3969/j.issn.1671-4091.2014.07.005

• 临床研究 • 上一篇    下一篇

终末期糖尿病肾病患者血液透析中低血压和高血压的相关因素分析

李锐钊,梁馨苓,黎思嘉,董伟,徐丽霞,李志莲,陶一鸣,刘双信,史伟   

  1.  广东省人民医院肾内科
  • 收稿日期:2014-01-13 修回日期:2014-04-29 出版日期:2014-07-12 发布日期:2014-07-12
  • 通讯作者: 史伟 shiwei.gd@139.com E-mail:weishi_gz@126.com
  • 基金资助:

    国家自然科学基金(81270784) 广东省科技计划基金(2010B031600157)

The factors relating to intradialytic hypotension and hypertension during hemodialysis session in patients with diabetic nephropathy

  • Received:2014-01-13 Revised:2014-04-29 Online:2014-07-12 Published:2014-07-12

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摘要： 目的观察终末期糖尿病肾病患者在维持性血液透析治疗中低血压与高血压的发生情况，探讨血压异常的影响因素。方法入组维持性血液透析的终末期糖尿病肾病患者，观察血液透析治疗中不同性别、年龄、透析年限、血流量、透析器通量及超滤率对血压的影响。结果透析年限是终末期糖尿病肾病患者血液透析治疗中血压异常的主要影响因素，以透析年限≤1 年、1-3 年、3-5 年和≥5 年分组，透析中低血压的发生率分别为13.8%、22.5%、26.7%和37.2%，组间差异具有统计学意义(χ2
≤1 年vs1- 3 年=23.129，P＜0.001；χ21-3 年vs≥5 年=22.889，P ＜0.001；χ23-5 年vs≥5 年=9.072，P =0.003)。透析中高血压的发生率分别为22.3%、14.2%、12.2%和8.1%，透析年限≤1 年组与其余各组比较，其差异均具有统计学意义(χ2≤1 年vs1-3 年=20.399，P＜0.001；χ2≤1 年vs3-5 年=22.774，P＜0.001；χ2≤1 年vs≥5 年=24.811，P＜0.001)。超滤率与透析中低血压相关(P =0.006)，但与透析中高血压无关(P =0.585)；余性别、年龄、透析器通量及血流量对透析中低血
压(P 性别=0.568；P 年龄=0.059；P 透析器通量=0.572；P 血流量=0.447)或高血压(P 性别=0.346；P 年龄=0.337；P 透析器通量=0.121；P 血流量=0.479)影响不大。结论随着透析年限的增加，透析中低血压的发生率明显增加，高血压的发生率却明显减少；而超滤率与透析中低血压相关。应注意不同透析年限的终末期糖尿病肾病患者血液透析中血压异常的特点，采取相应的预防措施，提高血液透析治疗的耐受性。

关键词: 糖尿病肾病, 血液透析, 透析年限, 低血压, 高血压

Abstract: Objective To evaluate the factors relating to intradialytic abnormal blood pressure through observation of the incidence of hypotension and hypertension during hemodialysis sessions in patients with diabetic nephropathy. Methods Patients with diabetic nephropathy treated with maintenance hemodialysis were recruited in this study. The effects of gender, age, dialysis age, blood flow, dialyzer and ultrafiltration rate on blood pressure were observed. Results Dialysis age was the main factor relating to intradialytic abnormal blood pressure in patients with diabetic nephropathy. The patients were divided into four groups based on dialysis age, group A (≤1 year), group B (1 to 3 years), group C (3 to 5 years) and group D (≥5 years). The incidence of intradialytic hypotension was 13.8%, 22.5%, 26.7% and 37.2% in group A, B, C and D, respectively, significant different between the four groups (χ2=23.129, P＜0.001 for group A vs. group B;χ2=22.889, P＜0.001 for group B vs. group D; χ2=9.072, P =0.003 for group C vs. group D). The incidence of intradialytic hypertension was 22.3%, 14.2%, 12.2% and 8.1% in group A, B, C and D, respectively, significant different between group A and other groups (χ2=20.399, P＜0.001 for group A vs. group B; χ2=22.774, P＜0.001 for group Avs. group C; χ2=24.811, P＜0.001 for group A vs. group D). Ultrafiltration rate was related to intradialytic hypotension (P=0.006), but not related to intradialytic hypertension (P=0.585). While gender, age, dialyser flux and blood flow were unrelated to intradialytic hypotension (P=0.568, 0.059, 0.572, and 0.447, respectively) and hypertension (P=0.346, 0.337, 0.121, and 0.479, respectively). Conclusion With the increase of dialysis age, the incidence of intradialytic hypotension significantly increased but the incidence of hypertension significantly reduced. Ultrafiltration rate was related to intradialytic hypotension. To raise the tolerance to he-modialysis, preventive measures should be conducted to the dialysis age-related intradialytic abnormal blood pressure in patients with diabetic nephropathy under hemodialysis.

Key words: Diabetic nephropathy, Hemodialysis, Dialysis expectancy, Hypotension, Hypertension