中国血液净化

中国血液净化 ›› 2020, Vol. 19 ›› Issue (10): 673-677.doi: 10.3969/j.issn.1671-4091.2020.10.007

• 临床研究 • 上一篇    下一篇

成人维持性血液透析患者透析间期血压变异性独立影响因素探讨

巩楠1,张学强1,袁铮1,韩晶1,张丽娜1,李慧君1,王泽香1   

  1. 1河北省邯郸市中心医院血液净化科
  • 收稿日期:2020-03-02 修回日期:2020-08-07 出版日期:2020-10-12 发布日期:2020-10-12
  • 通讯作者: 巩楠 gongnan756@163.com E-mail:gongnan756@163.com

The independent influencing factors for interdialytic blood pressure variability in adult maintenance hemodialysis patients

  1.  1Department of Blood Purification, Handan Central Hospital, Handan 056001, China
  • Received:2020-03-02 Revised:2020-08-07 Online:2020-10-12 Published:2020-10-12

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摘要： 【摘要】目的探讨成人维持性血液透析(maintenance hemodialysis，MHD)患者透析间期血压变异性(blood pressure variability,BPV)独立影响因素。方法选择河北省邯郸市中心医院2015 年1 月～2019 年9 月收治成人MHD 患者共505 例，根据收缩压(systolic blood pressure,SBP)变异系数=SBP 标准差/SBP 平均值×100%，透析间期SBP 变异系数四分位值(120,130,140,150)分为4 组，患者入院SBP 中位数148(128,170)mmHg，收缩压均数(mean systolic blood pressure,mSBP)中位数139(119,129,149, 159)mmHg，其中SBP 变异系数Q1(120～129mmHg) 设为低变异系数组(n=127)、SBP 变异系数Q2(130～139mmHg)设为中变异系数组(n=126)、SBP 变异系数Q3(140～149mmHg)设为高变异系数组(n=126)，SBP 变异系数Q4(150～159mmHg)设为极高变异系数组(n=126)。采用Logistic 回归模型分析透析间期SBP 变异系数独立影响因素。结果中变异系数患者透析时间少于其他3 组(t 值分别为3.556，3.674，4.403；P 值分别为0.024，0.028，0.018)；低变异系数患者合并2 型糖尿病比例多于其他3 组(χ2 值分别为5.567,5.567,4.764；P 值分别为0.027，0.031，0.020)，超滤量高于其他3 组(t 值分别为3.653，3.528，4.039；P 值分别为0.027，0.031，0.020)；低变异系数患者透析间期体质量增加量少于其他3 组(t 值分别为3.525，3.611，3.334；P 值分别为0.037，0.039，0.044)。高变异系数患者血钙水平高于其他3 组(t 值分别为3.346，3.211，3.509；P 值分别为0.031，0.036，0.030)。极高变异系数患者服用钙离子通道阻滞剂比例低于低变异系数组和高变异系数组(χ2值分别为5.534，6.588；P 值分别为0.012，0.010)。Logistic回归分析显示，透析间期体质量增加量升高是透析间期SBP 变异系数独立危险因素；超滤量升高和服用钙离子通道拮抗剂是透析间期SBP 变异系数独立保护因素。结论体质量增加量、超滤量及是否服用钙离子通道拮抗剂与成人MHD患者透析间期BPV 独立相关。

关键词: 成人, 维持性血液透析, 血压变异性, 影响因素

Abstract: 【Abstract】Objective To explore the independent influencing factors for interdialytic blood pressure variability (BPV) in adult maintenance hemodialysis (MHD) patients. Methods A total of 505 adult MHD patients treated in Handan Central Hospital between Jan 2015 and Sept 2019 were retrospectively analyzed. The coefficient of interdialytic systolic blood pressure (SBP) variation was calculated from the standard deviation of SBP / average SBP value x 100%. According to the interquartile values (120, 130, 140 and 150) of the coefficient of interdialytic SBP variation, the patients were divided into 4 groups: low coefficient of variation
group (n=127), medium coefficient of variation group (n=126), high coefficient of variation group (n=126), and extremely high coefficient of variation group (n=126). Clinical data, laboratory indicators and use of drugs were compared among the 4 groups. Logistic regression model was used to analyze the independent influencing factors for the coefficient of interdialytic SBP variation. Results In medium coefficient of variation group, dialysis time was less than the other 3 groups (t=3.556, 3.674 and 4.403 respectively; P=0.024, 0.028 and 0.018 respectively). In low coefficient of variation group, patients with type 2 diabetes were more than those in the other 3 groups (χ2=5.567, 5.567 and 4.764 respectively; P=0.027, 0.031 and 0.020 respectively), and ultrafiltration volume was higher than that in the other 3 groups (t=3.653, 3.528 and 4.039 respectively; P=0.027, 0.031 and 0.020 respectively). In low coefficient of variation group, interdialytic body weight gain was less than that in the other 3 groups (t=3.525, 3.611 and 3.334 respectively; P=0.037, 0.039 and 0.044 respectively). In high coefficient of variation group, serum calcium was higher than that in the other 3 groups (t=3.346, 3.211 and 3.509 respectively; P=0.031, 0.036 and 0.030 respectively). In extremely high coefficient of variation group, patients using calcium channel blockers were less than those in the other 2 groups (χ2=5.534 and 6.588; P=0.012 and 0.010). Logistic regression analysis showed that the higher interdialytic body weight gain was the independent risk factor for coefficient of interdialytic SBP variation, and that the increase of ultrafiltration
volume and the use of calcium channel blockers were the independent protective factors for coefficient of interdialytic SBP variation. Conclusion The size of interdialytic body weight gain, the ultrafiltration volume, and the use of calcium channel blockers were independently correlated with the interdialytic BPV in adult MHD patients.

Key words: Adult, Maintenance hemodialysis, Blood pressure variability, Influencing factor

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