中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (05): 293-296.doi: 10.3969/j.issn.1671-4091.2017.05.002

• 专题与讲座 • 上一篇    下一篇

血液透析中低血压的管理

高占辉1,刘静1,季大玺1   

  1. 南京医科大学附属明基医院 肾脏内科（高占辉和刘静为共同第一作者）
  • 收稿日期:2016-10-21 修回日期:2016-11-17 出版日期:2017-05-12 发布日期:2017-05-19
  • 通讯作者: 季大玺 dr_jdx@163.com E-mail:dr_jdx@163.com

Management of intra-dialytic hypotension

  • Received:2016-10-21 Revised:2016-11-17 Online:2017-05-12 Published:2017-05-19

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摘要： 近年来，尽管血液透析(hemodialysis，HD)技术有了很大的进展，但是血液透析中低血压(intra-dialytic hypotension，IDH)的发生率仍高达20%～30%。随着HD 患者老龄化，高血压和糖尿病肾病患者的增加，IDH 的发生率亦有增加趋势。IDH 的定义尚缺乏循证医学证据，2007 年欧洲最佳实践指南(european best practice guidelines，EBPG)强调符合美国肾脏病与透析病人生存质量指导指南(kidney disease outcomes quality initiative，K/DOQI)指南，并提出IDH是指HD过程中大于2次以上测定的收缩压较透析前降低≥20mmHg，或者平均动脉压下降≥10mmHg，同时伴有临床事件的发生需要干预[1]。2014 年Stefansson 等人进行的1 项回顾性研究，分析了2007～2008 年39497 例HD 患者的病历记录，使用美国肾脏病数据系统(the united states renal data system，USRDS)和透析中心提供的数据来判断患者预后，结果发现IDH与HD 患者心血管疾病的发病率和死亡率强相关[2] 。

关键词: 血液透析, 低血压

Abstract: Although the advances of hemodialysis (HD) technology have been made in recent years, the incidence of intra-dialytic hypotension (IDH) is still as high as 20～30%. The incidence of IDH increases associated the prevalence of aged patients, hypertensive nephropathy and diabetic nephropathy in HD patients. In 2007, the European Best Practice Guidelines (EBPG) emphasized the compliance with the Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines, and proposed that the definition of IDH was the decrease of intra-dialysis systolic blood pressure to ≥20mmHg for more than 2 times as compared with the pre-dialysis blood pressure or the decrease of mean arterial pressure to ≥10mmHg, accompanied by clinical events requiring medical intervention. In a retrospective study in 2014, Stefansson et al. analyzed the medical records of 39, 497 HD patients between 2007 and 2008 in the United States Renal Data System (USRDS) and hemodialysis centers in order to determine prognosis of the patients, and found that IDH was associated with increased risks of cardiovascular disease morbidity and mortality in HD patients.

Key words: hemodialysis, hypotension