目的  探讨维持性血液透析(maintenance hemodialysis,MHD)患者透析中血压变异性与透析后疲乏的关系。 方法  选取2024年11月—2025年2月在上海交通大学医学院附属仁济医院血液净化中心行MHD治疗的患者作为研究对象，收集患者透析治疗全程(共6次)的血压值，计算变异系数，采用视觉模拟疲乏量表评估透析后疲乏症状。分析透析中血压变异系数与透析后疲乏的相关性，依据血压变异系数的四分位数将患者各分为4组并进行组间比较。 结果  共纳入285例患者，透析后疲乏得分为4.00(3.00,6.00)分。相关性分析显示收缩压变异系数、舒张压变异系数、脉压变异系数与透析后疲乏均呈正相关(r=0.243,P＜0.001；r=0.108,P=0.034；r=0.119,P=0.023)。收缩压变异系数各组间[低变异性组(n=71)、中低变异性组(n=72)、中高变异性组(n=71)、高变异性组(n=71)]透析后疲乏递增(χ2=17.184，P=0.001)，舒张压变异系数各组间[低变异性组(n=71)、中低变异性组(n=72)、中高变异性组(n=71)、高变异性组(n=71)]透析后疲乏呈现先降后升的趋势(χ2=11.988，P=0.007)，脉压变异系数各组间[低变异性组(n=71)、中低变异性组(n=72)、中高变异性组(n=71)、高变异性组(n=71)]透析后疲乏比较差异无统计学意义(χ2=3.048，P=0.284)。老年(n=177)与非老年(n=108)MHD患者透析后疲乏分别受收缩压变异系数(χ2=17.208，P=0.001)、舒张压变异系数(χ2=11.275，P=0.010)影响。 结论  透析中血压变异性与透析后疲乏相关。老年与非老年MHD患者的透析后疲乏管理重点不同：老年患者应着重控制收缩压变异系数，非老年患者需关注舒张压变异系数。

Objective  To explore the relationship between blood pressure variability during dialysis and post-dialysis fatigue in maintenance hemodialysis (MHD) patients.  Method  Patients undergoing MHD at the Blood Purification Center of Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine from November 2024 to February 2025 were enrolled in this study. Blood pressure was measured for a total of 6 times in a hemodialysis session, and the coefficient of variation (CV) of blood pressure was calculated. The Visual Analog Fatigue Scale was used to evaluate post-dialysis fatigue symptoms. The relationship between CV of blood pressure during dialysis and post-dialysis fatigue was analyzed. Patients were divided into four groups based on the quartiles of CV of blood pressure. Comparisons were made among the groups.  Result  A total of 285 patients were included, with a post-dialysis fatigue score of 4.00 (3.00, 6.00). Correlation analysis showed that the CV of systolic blood pressure, diastolic blood pressure, and pulse pressure were positively correlated with post-dialysis fatigue (r=0.243, 0.108 and 0.119 respectively; P<0.001, 0.034 and 0.023 respectively). Intergroup comparisons showed that post-dialysis fatigue increased along with the groups of increased systolic blood pressure variation (for systolic blood pressure variation: low variation group 71 cases, medium-low variation group 72 cases, medium-high variation group 71 cases, and high variation group 71 cases; χ²=17.184, P=0.001); post-dialysis fatigue initially decreased and then increased along with the groups of increased diastolic blood pressure variation (for diastolic blood pressure variation: low group variation 71 cases, medium-low variation group 72 cases, medium-high variation group 71 cases, and high variation group 71 cases; χ²=11.988, P=0.007); post-dialysis fatigue had no correlation with pulse blood pressure variation among the groups (for pulse blood pressure variation: low variation group 71 cases, medium-low variation group 72 cases, medium-high variation group 71 cases, and high variation group 71 cases; χ²=3.048, P=0.284). Post-dialysis fatigue was predominantly affected by the CV of systolic blood pressure (χ2=17.208, P=0.001) in elderly MHD patients (n=177), and by the CV of diastolic blood pressure (χ2=11.275, P=0.010) in non-elderly MHD patients (n=108).  Conclusion Blood pressure variation during dialysis is associated with post-dialysis fatigue. The key point to manage post-dialysis fatigue is different between elderly and non-elderly MHD patients: control of systolic blood pressure variation is suitable for elderly MHD patients, whereas reduction of diastolic blood pressure variation is warranted for non-elderly MHD patients.