中国血液净化

中国血液净化 ›› 2013, Vol. 12 ›› Issue (11): 612-616.doi: 10.3969/j.issn.1671-4091.2013.11.00

• 临床研究 • 上一篇    下一篇

个体化治疗模式对高血压维持性血液透析患者居家血压变异度的影响

  

  1. 1. 北京市垂杨柳医院
    2. 首都医科大学附属北京朝阳医院
    3. 北京朝阳医院
  • 收稿日期:2013-05-21 修回日期:2013-09-03 出版日期:2013-11-12 发布日期:2013-11-12
  • 通讯作者: 周亦伦 E-mail:zhouyilun2008@yahoo.cn

Effects of individualized interventions on home blood pressure and blood pressure variability in maintenance hemodialysis patients with hypertension

  • Received:2013-05-21 Revised:2013-09-03 Online:2013-11-12 Published:2013-11-12

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摘要： 【摘要】目的：了解高血压血液透析（hemodialysis，HD）患者居家血压变异度状况，并观察根据HD患者高血压发病机制进行个体化治疗后，HD患者居家血压变异度的变化情况。方法：选取北京朝阳医院肾内科透析室部分稳定维持性HD患者进行家庭血压（Home-BP）监测，了解HD患者居家血压变异度情况，以居家血压的变异系数表示血压变异度。并以家庭收缩压≥150mmHg(1mmHg=0．133kPa)为未控制的高血压的诊断标准，对未控制的高血压患者进行生物电阻抗监测、透析前后血清钠测定、药物使用情况调查，了解水、钠负荷及药物应用合理性情况，进而针对性地分别进行降低干体重、应用低钠透析液和合理使用降压药物的干预措施。随访2个月，观察患者血压及血压变异度情况。结果：共有105例稳定维持HD患者进行家庭血压监测，患者居家血压变异度为4.8±2.2/5.0±2.4%。未控制的高血压患者有60例（57.1%），经个体化降压治疗后，居家血压从166.3±12.6/87.5±11.7mmHg降至154.1±14.2/82.6±11.4mmHg（P<0.001，T=7.223；P<0.001，T=4.796），收缩压变异度由4.9±2.2%降至4.6±2.5%（P=0.340，T=0.961）。其中30例容量超负荷患者，予降低干体重后，家庭收缩压和舒张压明显降低，变异系数分别下降0.4%和0.1%（P=0.027，T=2.329；P=0.041，T=2.138）。12例患者应用低钠透析液(136mmol/L)后，居家血压下降，血压变异度无明显改变。其余18例容量负荷正常、未使用低钠透析的患者通过增加肾素-血管紧张素抑制剂和αβ受体阻滞剂等，居家血压下降，血压变异度减小，但未达统计学差异。结论：针对高血压HD患者高血压的病因进行治疗，能够有效地改善患者的家庭血压及血压变异度。

关键词: 血液透析, 高血压, 家庭血压监测, 血压变异度

Abstract: 【Abstract】 Objective To investigate home blood pressure variability in maintenance hemodialysis patients(MHD) with hypertension , and then observe the effects of individualized therapeutic interventions on home blood pressure variability in these patients. Methods Home blood pressure monitoring was carried out in stable MHD in our hospital. The coefficient of variation(CV) was used as indicator parameters for variability of home blood pressure. Home systolic blood pressure ≥ 150mmHg was defined as uncontrolled hypertension. Patients with uncontrolled hypertension were subject to bioimpendance analysis, serum sodium measurement, and antihypertensive agent evaluation. Individualized interventions including reducing dry body weight, negative sodium gradient dialysis and re-adjusting antihypertensive agents were applied accordingly. The patients were followed for 2 months, home blood pressure and blood pressure variability were monitored. Results Total 105 MHD patients conducted home blood pressure monitoring. The average CV of home blood pressure was 4.8±2.2/5.0±2.4%. Among the 105 patients, 60 patients were determined as uncontrolled hypertensive patients(57.1%). After the individualized interventions, home blood pressure fell from 166.3±12.6/87.5±11.7mmHg to 154.1±14.2/82.6±11.4mmHg（P<0.001,T=7.223,P<0.001,T=4.796）， home systolic blood pressure variability fell from 4.9±2.2% to 4.6±2.5%. Thirty overhydrated patients had their dry body weight reduced under guidance of bioimpedance technique, which resulted in significant decreases in home blood pressure, CV of home systolic and diastolic blood pressure (0.4% and 0.1%) and dose of antihypertensive agents. Twelve patients were subject to negative sodium gradient dialysis, significant decrease in home blood pressure were discovered, however, there is no difference in home blood pressure variability was detected. The other 18 patients had their home blood pressure significantly reduced by re-adjusting antihypertensive drugs; no siginificant change in coefficient of variation of home blood pressure was found. Conclusions Individualized interventions can improve home blood pressure control and blood pressure variability.

Key words: hemodialysis, hypertension, home blood pressure mornitoring, blood pressure variability