中国血液净化

›› 2010, Vol. 9 ›› Issue (10): 550-553.doi: 10.3969/j.issn.1671-4091.2010.10.00

• 临床研究 • 上一篇    下一篇

糖尿病与非糖尿病血液透析患者血压差异的探讨

张国娟 黄 雯   

  1. 首都医科大学附属北京同仁医院肾内科
  • 收稿日期:2010-06-21 修回日期:1900-01-01 出版日期:2010-10-12 发布日期:2010-10-12
  • 通讯作者: 黄雯

The difference of blood pressure in hemodialysis patients with and without diabetic mellitus

ZHANG Guo-juan, HUANG Wen   

  1. Department of Nephrology, Beijing Tongren Hospital, Beijing 100730, China
  • Received:2010-06-21 Revised:1900-01-01 Online:2010-10-12 Published:2010-10-12

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摘要：

【摘要】目的 观察糖尿病维持性血液透析患者血压特点及透析中血压的变化。方法 选取首都医科大学附属北京同仁医院血液透析中心36例稳定的维持性血液透析患者，分为糖尿病组及非糖尿病组，分析两组患者透析前后血压达标情况及两组间血压的差异，并比较两组患者透析低血压的发生情况。结果 血液透析患者血压达标率低，糖尿病组与非糖尿病组患者血压透析前达标率分别为26.7%和28.6%，透析后达标率分别为57.8%和55.6%，两组比较差异均无统计学意义(P＞0.05)。糖尿病组服用降压药物患者的比例及种类显著高于非糖尿病组(P＜0.05)。糖尿病组和非糖尿病组患者透析前平均收缩压（systolic blood pressure,SBP）分别为(163±29)mm Hg(1 mm Hg=0.133 kPa) 和(153±23)mm Hg，脉压(pulse pressure,PP)分别为(83±25)mm Hg和(70±22)mm Hg，两组比较差异均有统计学意义(P＜0.05)，两组平均舒张压(diastolic blood pressure,DBP) 差异无统计学意义(P＞0.05)。透析后糖尿病组患者平均SBP及PP与非糖尿病组差异无统计学意义(P＞0.05)，而平均DBP显著低于非糖尿病组患者，分别为(70±14)mm Hg及(80±15)mm Hg，差异有统计学意义(P＜0.05)。非糖尿病组患者透析后SBP及DBP较透析前下降幅度分别为(19±29)mm Hg和(3±16)mm Hg，糖尿病组患者相应下降幅度分别为(37±38)mm Hg和(10±17)mm Hg，显著高于非糖尿病患者(P＜0.05)。糖尿病组透析低血压发生率高于非糖尿病组，分别为62.2%和41.3%，症状性低血压发生率也高于非糖尿病组，分别为31.1%和7.9%，两组比较差异均有统计学意义(P＜0.05)。对可能引起透析低血压的因素进行logistic回归分析，结果显示是否合并糖尿病及总超滤量较高为引起低血压的危险因素（OR=2.572,0.597,均P＜0.05）。结论 维持性血液透析患者血压达标率较低，而糖尿病患者较非糖尿病患者血压更难控制，脉压差更大，透析过程中血压波动大，更易发生低血压。

关键词: 血液透析, 糖尿病, 收缩压, 舒张压, 脉压, 低血压

Abstract:

【Abstract】 Objective To investigate the characteristic of blood pressure and the change of blood pressure during hemodialysis (HD) in hemodialysis patients with diabetic mellitus. Methods We studied 3 consecutive HD sessions in 36 stable maintained HD (MHD) patients (totally 108 dialysis sessions), and divided the patients into 2 groups: diabetic group and non-diabetic group. Blood pressures before and after dialysis were compared between the two groups. HD-related hypotension was also analyzed. Results The ratio of patients with the blood pressure reached to the target of K/DOQI was 26.7% (pre-dialysis) and 57.8% (post-dialysis) in diabetic patients, and was 28.6% (pre-dialysis) and 55.6% (post-dialysis) in non-diabetic patients, without significant differences between the two groups. The number of patients taking anti-hypertensive medicines and the kinds of a tensive medicines administered were more in diabetic group than in diabetic group (P＜0.05). In patients before dialysis, the average systolic blood pressure (SBP) and pulse pressure (PP) were 163+29mmHg and 83+25mmHg, respectively, in diabetic group, higher than those in non-diabetic group (153+23mmHg and 70+22mmHg, respectively; P＜0.05). However, diastolic blood pressure (DBP) had no significant differences between the two groups. In patients after dialysis, SBP and PP showed no significant differences between the two groups, and DBP was lower in diabetic group than in non-diabetic group (70+14mmHg and 80+15mmHg, respectively; P＜0.05). In diabetic group after dialysis, SBP and DBP decreased by 37+38mmHg and 10+17mmHg, respectively, as compared with the values before dialysis. In non-diabetic group after dialysis, the decrease of SBP and DBP were less (19+29mmHg and 3+16mmHg, respectively; P＜0.05). In diabetic group, patients with dialysis-related hypotension and symptomatic hypotension were 62.2% and 31.1%, respectively, higher than those in non-diabetic patients (41.3% and 7.9%, respectively; P＜0.05). Multiple regression analysis indicated that diabetes and higher ultrafiltration volume were the risk factors for HD-related hypotension. Conclusion The ratio of patients with the blood pressure reached to the target of K/DOQI was very low in this study. Patients with diabetes had hypertension more difficult to control and a higher PP. These patients also showed wider change of blood pressure during HD, and were prone to HD-related hypotension.

Key words: Diabetic mellitus, Blood pressure, Pulse pressure, Hypotension