中国血液净化

中国血液净化 ›› 2020, Vol. 19 ›› Issue (08): 513-516.doi: 10.3969/j.issn.1671-4091.2020.08.003

• 临床研究 • 上一篇    下一篇

透析间期体质量增长情况与透析性低血压的相关性分析

张红1,周培一1,党毅1,王甲正1   

  1. 1首都医科大学大兴教学医院肾内科
  • 收稿日期:2019-11-28 修回日期:2020-06-08 出版日期:2020-08-12 发布日期:2020-08-12
  • 通讯作者: 张红 m17114514856@163.com E-mail:m17114514856@163.com

Correlation between interdialytic weight gain and intradialytic hypotension 

  1. 1Department of Nephrology, Daxing Teaching Hospital of Capital Medical University, Beijing 102600, China
  • Received:2019-11-28 Revised:2020-06-08 Online:2020-08-12 Published:2020-08-12

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摘要： 【摘要】目的分析透析间期体质量增长情况与透析性低血压(intradialytic-hypotension，IDH)的相关性。方法纳入2017 年1 月～2018 年6 月首都医科大学大兴教学医院收治的146 例维持性血液透析(maintenance hemodialysis,MHD)患者，所有患者均行规律性碳酸氢盐透析，3 次/周，收集患者的基线资料、血生化、透析前后体质量、透析前后血压等资料，根据透析过程中是否出现IDH，分为IDH 组(53例)和无IDH 组(93 例)，进行影响IDH 发生的相关因素分析，分析透析间期体质量增长量(interdialysis weight gain,IDWG)、IDWG%与透析前后血压下降值的相关性。结果IDH 组年龄、糖尿病占比、IDWG、IDWG%、透析前收缩压(systolic blood pressure, SBP)、透析前平均动脉压(mean arterial pressure, MAP)、超滤量、超滤率均高于无IDH 组(t=χ2=6.413, 12.23, 6.821, 6.561, 3.123, 10.059, 9.717, P 均＜0.001)，IDH 组透析前白蛋白低于无IDH 组(t=3.852，P＜0.001)；年龄(OR=2.186,95% CI:1.329～3.596, P= 0.002)、透析前SBP(OR=2.232, 95% CI:1.338～3.723, P=0.002)、IDWG(OR=2.815, 95% CI:1.557～5.088, P=0.001)、IDWG% (OR= 3.093, 95% CI:1.671～5.723, P＜0.001)、超滤量(OR=2.109,95% CI:1.216～3.657, P=0.008)、超滤率(OR=2.284,95% CI: 1.375～3.795,P=0.002)是MHD 患者透析过程中发生IDH 的独立危险因素；MHD 患者IDWG、IDWG%与透析前后SBP (r=0.372, 0.379, P 均＜0.001)、舒张压(diastolic blood pressure,DBP) (r=0.381, 0.395, P 均＜0.001)、MAP 下降值均呈正相关(r=0.314,
0.305, P=0.002,0.003)；IDWG% ≥4.1% 者IDH 发生风险高于IDWG% ＜4.1% 者(Log- rank=21.670，P＜0.001)。结论影响MHD 患者透析过程中发生IDH 的因素较多，透析间期体质量增长与IDH 的发生具有相关性，应加强患者透析期间的体质量控制。

关键词: 维持性血液透析, 体质量增长, 透析性低血压, 危险因素

Abstract: 【Abstract】Objective To analyze the correlation between interdialytic weight gain and intradialytic hypotension (IDH). Methods A total of 146 patients with maintenance hemodialysis (MHD) admitted to Daxing Teaching Hospital of Capital Medical University from January 2017 to June 2018 were enrolled in this study. All patients underwent regular bicarbonate dialysis (3 times/week). Their baseline data, blood biochemistry, body mass before and after dialysis, and blood pressure before and after dialysis were collected. According to the presence or absence of IDH during dialysis, the patients were divided into IDH group (53 cases) and non-IDH group (93 cases). The analysis of related factors affecting IDH was performed. The correlation between interdialytic weight gain (IDWG), IDWG% and blood pressure reduction before and after dialysis was analyzed. Results Age, prevalence of diabetes, IDWG, IDWG%, systolic blood pressure (SBP) before dialysis, mean arterial pressure (MAP) before dialysis, ultrafiltration volume and ultrafiltration rate in IDH group were higher than those in non-IDH group (t or χ2=6.413, 12.23, 6.821, 6.561, 3.123, 10.059 and 9.717 respectively; P＜0.001). Albumin before dialysis in IDH group was lower than that in non- IDH group (t=3.852, P＜0.001). Age (OR=2.186, 95% CI: 1.329～3.596, P=0.002), SBP before dialysis (OR=2.232, 95% CI:1.338～3.723, P=0.002), IDWG (OR=2.815, 95% CI:1.557～5.088, P=0.001), IDWG% (OR=3.093, 95% CI: 1.671~5.723, P＜0.001), ultrafiltration volume (OR=2.109, 95% CI: 1.216～3.657, P=0.008) and ultrafiltration rate (OR=2.284, 95% CI: 1.375～3.795, P=0.002) were the independent risk factors for IDH during dialysis in MHD patients. IDWG and IDWG% were positively correlated with the reductions of SBP (r=0.372 and 0.379; P＜0.001), DBP (r=0.381 and 0.395; P＜0.001) and MAP (r=0.314 and 0.305; P=0.002 and 0.003) before and after dialysis. The risk of IDH in patients with IDWG% ≥4.1% was higher than that in patients with IDWG% ＜4.1% (log rank test=21.670, P＜0.001). Conclusion There are many factors affecting the occurrence of IDH during dialysis in MHD patients. Interdialytic weight gain is related to the occurrence of IDH. It is necessary to strictly control the interdialytic weight gain.

Key words: Maintenance hemodialysis, Body mass growth, Intradialytic hypotension, Risk factor

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