中国血液净化

›› 2007, Vol. 6 ›› Issue (4): 184-187.

• 论著 • 上一篇    下一篇

维持性血液透析合并高血压治疗状况的多中心调查

吕玉风1 刘必成1 邢昌赢2 张 苗3 孙 伟4 楼季庄5 张晓良1 王艳丽1   

  1. 210009 1. 南京，东南大学中大医院肾脏病研究所 2. 江苏省人民医院肾内科 3. 江苏省南京鼓楼医院肾内科 4。 江苏省中医院肾内科 5。 江苏省南京市第一医院肾内科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2007-04-12 发布日期:2007-04-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2007-04-12 Published:2007-04-12

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摘要： 目的 调查分析维持性血液透析(MHD)患者高血压治疗现状及相关危险因素。方法 对南京市5所三级甲等医院297例MHD合并高血压患者的有关临床资料进行调查，用多因素Logistic回归分析该组人群人口学资料、透析时间、透析剂量、降压药物应用情况以及各种实验室参数与透析前、透析后高血压的关系。结果 ①297例MHD患者中，221例(74.4%)血压控制不理想[透析前和(或)透析后血压≥140/90mm Hg(1mm Hg=0.133kpa)]，242例患者服用降压药物，其中91例(37.6%)用单药降压，151例(62.4%)患者联合降压；所有降压药物中CCBs应用最为广泛(85.1%)，其次为β-受体阻滞剂、ACEIs、ARBs(分别为44.6%、20.7%、16.5%)，所有患者平均用药数量为1.54种；② MHD患者主要以单纯收缩压(收缩压≥140 mm Hg，舒张压＜90mm Hg)升高为主，透析前、透析后所占比例分别为63.9%、72.0%。单纯舒张压升高(收缩压＜140mm Hg,舒张压≥90mm Hg)的患者较少(透析前、透析后仅为2.1%、6.9%)；③ 应用降压药物数量与血红蛋白浓度(r=-0.250,P=0.001)存在负相关关系。④ 多因素Logistic回归分析表明透析不充分(Kt/V＜1.4)(OR = 5.308，95%CI 1.608～17.560)、血红蛋白浓度(OR=0.956，95%CI 0.914～0.999)是透析前血压未得到控制的主要危险因素；中重度贫血(OR=2.493，95% CI 1.085～5.728)是透析后血压未得到控制的主要危险因素。结论 MHD患者高血压控制不达标仍较突出，以收缩压升高为主，提高透析充分性、纠正贫血可能有助于透析患者血压控制。

关键词: 血液透析, 高血压, 贫血, 透析充分性

Abstract: Objective Hypertension is still a challenge for the treatment of maintenance hemodialysis patients. The present study was designed to retrospectively investigate the treatment status for hypertension in these patients in Nanjing area. Methods Two hundred and ninety-seven maintenance hemodialysis patients with hypertension from 5 hemodialysis centers in Nanjing area were involved. Logistic regression model was used to analyze the correlation of hypertension to demographic variables, duration of dialysis, dosage of dialysis per week, antihypertensive therapy, physical examination, and laboratory variables. Blood pressure (BP) measurements were obtained before and after each dialysis. Results ① BP was unsatisfactorily controlled in 74.4% of the 297 patients (pre- and/or post-dialysis BP ≥140/90mmHg). Antihypertensives were prescribed for 242 patients (81.5%). Among them 37.6% patients were treated with single drug, and 62.4% with two or more than two drugs. Calcium channel blockers were prescribed to 85.1% of the patients. β-adrenergic receptor blockers, angiotensin II converting enzyme inhibitors (ACEIs), angiotensin II blockers (ARBs) were prescribed to 44.6%, 20.7%, 16.5% of the patients, respectively. The average number of prescribed antihypertensives was 1.54. ② Systolic hypertension without diastolic hypertension (≥140/<90mmHg) was found in most of the uncontrolled hypertensive patients, accounting for 63.9% and 72.0% of the patients in the pre- and post-dialysis periods, respectively. Diastolic hypertension without systolic hypertension (＜140/>90mmHg) only occurred in 2.1% and 6.9% of the pre- and post-dialysis patients, respectively. ③ The number of antihypertensives used was negatively correlated with the hemoglobin concentration (r=-0.250, P=0.001). ④ Multivariable analyses indicated that the risk factors for the unsatisfactory control of hypertension were inadequate dialysis (Kt/V＜1.4) (OR=5.308, 95% CI=1.608-17.560) and hypohemoglobinemia (OR=0.956, 95% CI = 0.914 - 0.999) in the pre-dialysis period, and moderate and severe anemia (OR=2.493, 95% CI=1.085-5.728) in the post-dialysis period. Conclusion Unsatisfactory control of hypertension predominately manifested by systolic hypertension in maintenance hemodialysis patients is still a clinical challenge. Appropriate dialysis, treatment of anemia and judicious use of antihypertensives may be helpful to improve this clinical problem.

Key words: Hypertension, Anemia, Dialysis adequacy

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