维持性血液透析诱发低血压的危险因素

Risk factors of hypotension caused by maintenance hemodialysis

目的 探讨维持性血液透析(MHD)患者发生低血压的相关因素。方法 选取2015-12至2020-12武警北京总队医院门诊部行MHD治疗患者257例,其中发生低血压89例患者为观察组,未发生低血压168例为对照组。比较两组患者年龄、性别、透析超滤率、血红蛋白(Hb)、白蛋白(ALB)、甲状旁腺激素(PTH)等指标水平,以及伴糖尿病、心功能不全、自主神经功能障碍等并发症的情况。结果 两组性别、年龄、Hb、PTH无统计学差异(P>0.05);透析超滤率、白蛋白水平、糖尿病、心功能不全、自主神经功能障碍有统计学差异(P<0.05)。多因素Logistic回归分析提示超滤率、糖尿病、心功能不全和心率变异性为血液透析低血压的独立影响因素,调整OR值分别为1.07(95%CI:1.03~1.11), 1.27(95%CI:1.15~2.41),1.98(95%CI:1.76~2.13)和0.95(95%CI:0.91~0.99)。结论 MHD患者发生低血压与超滤率直接相关,糖尿病、心功能不全、营养不良、自主神经功能障碍是发生低血压的危险因素。

Objective To analyze the related factors of hypotension caused by maintenance hemodialysis.Methods Two hundred and fifty-seven patients who underwent outpatient maintenance hemodialysis in Beijing Municipal Corps Hospital from December 2015 to December 2020 were collected as the research objects, including 89 patients with hypotension as the observation group and 168 patients without hypotension as the control group. The age, gender, dialysis ultrafiltration rate, hemoglobin(Hb), albumin(ALB), parathyroid hormone(PTH) and other indexes of two groups were compared, and the situation of diabetes, cardiac dysfunction and autonomic nervous dysfunction were compared.Results There were no statistical differences in sex, age, Hb, and PTH between the two groups(P>0.05), and there were statistical differences in dialysis ultrafiltration rate, albumin level, diabetes mellitus, cardiac insufficiency, and autonomic dysfunction(P<0.05). The results of multivariate logistic regression analysis showed that ultrafiltration rate, diabetes, cardiac insufficiency and cardiac variability were independent influencing factors of maintenance hemodialysis hypotension, with the adjusting OR values of 1.07(95% CI: 1.03-1.11), 1.27(95% CI: 1.15-2.41), 1.98(95% CI: 1.76-2.13) and 0.95(95% CI: 0.91-0.99), respectively.Conclusions Hypotension caused by maintenance hemodialysis is directly related with ultrafiltration rate, and the complications of diabetes, heart failure, malnutrition and autonomic dysfunction are risk factors for hypotension.