慢性肾衰竭终末期高血压40例疗效观察

Clinical Observation on Therapeutic Effect of 40 Cases of End-stage Chronic Renal Function Failure-induced Hypertension

目的观察透析治疗、降压药物治疗对慢性肾衰竭(CRF)终末期高血压的降压效果。方法收集CRF终末期高血压患者40例,分为透析组(22例)和非透析治疗组(18例)进行治疗并分析其疗效。结果①透析组5例患者经充分透析后血压降至目标值(130/80mmHg),其余17例加用血管紧张素转换酶抑制剂(ACEI)、钙离子通道阻滞剂(CCB)治疗后仍有2例血压难以降至目标值,此时加用利尿剂、β-受体阻滞剂后降至目标值以下。②非透析组均服用CCB,12例患者血压难以降至目标值,加用利尿剂、β-受体阻滞剂后6例降至目标值以下。结论充分透析可有效降压,在此基础上合理联用ACEI、CCB及β-受体阻滞剂,同时纠正钙磷比例失调,控制甲状旁腺功能亢进可增强降压效果。

Objective To observe the therapeutic effect of hemodialysis or hypotensive drugs in the treatment of 40 cases of end-stage chronic renal function failure-induced hypertension. Methods Forty patients with end-stage chronic renal function failure-induced hypertension admitted on our hospital during 2001.1-2007.7 were randomly divided into two groups： hemodialysis group （n=22） and non-hemodialysis group （n=18）. The therapeutic effectiveness was analyzed. Results In hemodialysis group, blood pressure was reduced to the target value （130/80 mmHg）in 5 cases after sufficient hemodialysis. And in the remaining 17 cases, blood pressure of 15 cases reached the target value after combined use of angiotensin converting enzyme inhibitor （ACEI）, calcium channel blocker （CCB）, and that of 2 cases reached the target value after combined use of ACEI, CCB, diuretic agent, β-receptor blocker, etc. In non-hemodialysis group, all patients were administered with calcium channel blocker, but blood pressure of 12 cases did not reach the target value. After combined use of diuretic agent, β-receptor blocker, etc, blood pressure of 6 cases was reduced to below the target value.Conclusion Sufficient hemodialysis can lower blood pressure effectively. Combined use of ACEI, calcium channel blocker and β-receptor blocker, and correcting the imbalance between calcium and phosphonium and controlling hyperparathyroidism can reach the satisfactory therapeutic effects in lowering blood pressure.