维持性血液透析患者心血管事件发生的影响因素

Influencing Factors of Cardiovascular Events in Patients with Maintenance Hemodialysis

目的:了解维持性血液透析患者心血管事件的发生情况,并对影响因素进行分析。方法:选择在郑州市第七人民医院2018年1月至2020年10月期间行维持性血液透析的162例终末期肾脏疾病(ESRD)患者作为研究对象,回顾性调查发生心血管事件的情况,并对患者的一般情况、透析前电解质、心脏彩色多普勒超声以及透析相关指标进行调查,采用Logistic回归分析确定维持性血液透析患者心血管事件发生的独立危险因素。结果:所有研究对象在维持性血液透析期间发生心血管事件64例,占比39.51%,包括心律失常23例、心绞痛17例、心肌梗死13例、急性冠状动脉综合征11例。心血管事件组和非心血管事件组在年龄、合并高血压、合并高脂血症、透析前血钾水平、透析前血镁水平、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、透析月龄和透析超滤率等单因素指标比较,差异均具有统计学意义(P<0.05)。经多因素Logistic回归分析发现,心血管事件发生的独立危险因素包括合并高血压、透析前血钾水平低、透析前血镁水平低、透析月龄长和透析超滤率高。结论:心血管事件是维持性血液透析中常见的并发症,其独立危险因素主要包括合并高血压、透析前血钾水平、透析前血镁水平、透析月龄和透析超滤率,为维持性血液透析患者制定个体化的防控方案提供临床依据。

Objective To investigate the incidence of cardiovascular events in patients with maintenance hemodialysis and analyze the influencing factors.Methods A total of 162 patients with end stage renal disease(ESRD)who underwent maintenance hemodialysis in Zhengzhou No.7 People's Hospital from January 2018 to October 2020 were selected as the research subjects.The incidence of cardiovascular events were retrospectively investigated,and the general condition,pre-dialysis electrolyte,cardiac ultrasound,and dialysis related indicators were investigated.The influencing factors of cardiovascular events in maintenance hemodialysis patients were analyzd by Logistic regression analysis.Results During maintenance hemodialysis,64 cases of cardiovascular events occurred in all subjects,accounting for 39.51%,including 23 cases of arrhythmia,17 cases of angina,13 cases of myocardial infarction,and 11 cases of acute coronary syndrome.Age,hypertension,hyperlipidemia,serum potassium level before dialysis,serum magnesium level before dialysis,left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),dialysis months and dialysis ultrafiltration rate were compared between the cardiovascular event group and the non-cardiovascular event group,the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that independent risk factors for cardiovascular events included hypertension,low serum potassium level before dialysis,low serum magnesium level before dialysis,long dialysis months,and high dialysis ultrafiltration rate.Conclusion Cardiovascular events are common complications in maintenance hemodialysis,and their independent risk factors mainly include hypertension,pre-dialysis serum potassium level,pre-dialysis serum magnesium level,dialysis months and dialysis ultrafiltration rate,which provide clinical basis for the development of individualized prevention and control programs for maintenance hemodialysis patients.