中国血液净化

中国血液净化 ›› 2014, Vol. 13 ›› Issue (11): 767-771.doi: 10.3969/j.issn.1671-4091.2014.11.007

• 临床研究 • 上一篇    下一篇

维持性血液透析患者体液分布与透析相关低血压的关系

池向耿1 ,李香茶2 ,蔡琪1 ,马伟平1 ,许敏玲1 ,丁德良1   

  1. 528415 中山，1中山市小榄人民医院肾内科
    310007 杭州，2杭州市中医院肾内科
  • 收稿日期:2014-03-19 修回日期:2014-06-23 出版日期:2014-11-12 发布日期:2014-11-12
  • 通讯作者: 池向耿 chixgg@126.com E-mail:chixgg@126.com
  • 基金资助:

    中山市科技计划项目(20113A142)

A study on the relationship between body-fluid distribution and intradailytic-hypotension among maintenance hemodialysis patients

  • Received:2014-03-19 Revised:2014-06-23 Online:2014-11-12 Published:2014-11-12

RichHTML

0

PDF

276

摘要： 【摘要】目的分析维持性血液透析（maintenance hemodialysis，MHD）患者透前体液分布情况与透析相关性低血压（intradialytic-hypotension，IDH)发生的关系，为透析超滤方案制定提供依据。方法应用生物电阻抗测量42例符合研究条件患者620次血液透析过程体液分布情况以及记录血压变化、低血压发生情况，根据是否出现透析相关性低血压分为低血压组和非低血压组，比较两组透前体液分布、血压变化等情况，应用Logistic回归分析体液分布指标与透析相关性低血压发生的相关性。结果620次血液透析过程共出现143次透析相关性低血压，发生率为23.06%，多因素Logistic回归分析提示透前细胞外液、透前收缩压、总体水/体重、千克体重总体液超滤速度与透析相关低血压发生相关（P＜0.05）。进一步的受试者工作曲线（ROC）分析发现，千克体重总体液超滤速度判断透析相关性低血压发生的曲线下面积（AUC）为0.680（95%CI：0.632~0.727，P=0,000），以界值0.198ml/kg.min预测透析相关性低血压敏感度为89.5%，特异度为60.5%。结论高超滤速度、透前高收缩压、低细胞外液、低总体水/体重比值是透析相关性低血压体液相关的危险因素，千克体重总体液超滤速度可作为透析相关性低血压的预测因子。

关键词: 维持性血液透析, 透析相关性低血压, 体液分布, 生物电阻抗

Abstract: 【Abstract】 Objective To analysis the relationship between body-fluid distribution before hemodialysis and intradialytic-hypotension (IDH) among maintenance hemodialysis (MHD) patients，and to provide clinically basis for preventing IDH. MethodsDataofbody-fluid distributionpre-hemodialysis measured by Bio-impedance Electrical Spectroscopy（BIS）and blood pressure changes during hemodialysis were recorded in 620 hemodialysissessionsof 42 MHD patients in 6 weeks. According to the occurrence of IDH，620 hemodialysis sessions were divided into hypotension group and Non-hypotension group. Body-fluid distribution and blood pressure changes were compared between the two groups. Furthermore Logistic regression analysis was use to access the risk factors of IDH among body-fluid distribution. 143 IDHs occurred in 620 hemodialysis sessions, incidence rate of IDH was 23.06%. Logistic regression analysis revealed that Extracellular Fluid (ECV)、systolic pressure、total water/weight ratio(TW/W) of pre-hemodialysis and ultrafiltration speed(UFS) calculated by TW removed （ml/kg.min）were risk factors for IDH（P＜0.05）. ROC curve was used to predict IDH among risk factors pre-hemodialysis. UFS was correlated with IDH, the area under the ROC curve (AUC) of IDH was 0.680 (95% CI: 0.632～0.727，P=0,000),the sensitivity and specificity for IDH were 89.5% and60.5% respectively when the cutoff value was 0.198ml/kg.min. Conclusion Higher ultrafiltration speed、higher systolic pressure、total water/weight ratio of pre- hemodialysis were risk factors for IDH. Ultrafiltration speed calculated by TW removed of pre-hemodialysis can be used for predicting IDH.

Key words: Maintenance hemodialysis, Intradialytic-hypotension, Body-fluid distribution, Bio-impedance Electrical Spectroscopy