维持性血液透析患者透析相关性低血压及其相关因素分析

Intradialytic hypotension and its influence factors in patients with maintenance hemodialysis

目的对维持性血液透析患者透析相关性低血压的相关因素进行探讨。方法选择维持性血液透析患者80例,将入选的患者根据年龄分为3组,Ⅰ组:年龄<45岁25例;Ⅱ组:45岁≤年龄<65岁23例;Ⅲ组:年龄>65岁32例。分析年龄、透析过程平均心率、透析前平均动脉压(PreMAP)、透析间期体重增长率(IDWG%)与透析相关性低血压的关系。结果①全部4899例次透析中,共出现820例次低血压,其发生率18.2%。在透析过程中,451例次透析相关性低血压出现在透析开始后1h(50.6%),其次为透析开始后2h(25.0%)、3h(5.2%)、透析结束后(19.2%)。②与Ⅰ、Ⅱ组相比较,Ⅲ组透析相关性低血压发生率高于Ⅰ、Ⅱ组,差异有统计学意义(P<0.05);与Ⅰ组比较,Ⅱ组透析相关性低血压发生率高于Ⅰ组,差异有统计学意义(P<0.05)。③发生透析相关性低血压的例次,其透析前PreMAP显著高于未发生透析相关性高血压例次(P<0.01);其透析过程平均心率和ID-WG%高于未发生透析相关性低血压例次(P<0.05)。④Logistic回归分析,透析相关性低血压的发生与透析前PreMAP、IDWG%呈正相关。结论维持性血液透析患者透析过程心率越快、IDWG%越多、PreMAP越高,越容易出现透析相关性低血压。

Objective To investigate the incidence of intradialytic hypertension and its influence factors in patients with maintenance hemodialysis.Methods 80 patients with hemodialysis were divided into three groups： groupⅠ（n=25,age45 year-old）;groupⅡ（n=23,45≤age65 year-old） and groupⅢ（n=32,age65 year-old）.Intradialytic hypotension events were recorded in 4899 dialysis subjects from July of 2010 to December of 2010.The influence factors of intradialytic hypotension events were recorded and analyzed.Results There were 820 cases with hypotension out of 4899 visiting patients（18.2%）.451 cases with intradialytic hypotension were happened one-hour after the start of dialysis（50.6%）,and followed by two-hour after the start of dialysis（25.0%）,after the end of dialysis（19.2%） and three-hour（5.2%）.The incidence of intradialytic hypotension were higher in group Ⅲ than that in Ⅰgroup and groupⅡ（P0.05）;the incidence of intradialytic hypotension were higher in group Ⅱthan that in groupⅠ（P0.05）.PreMAP were significantly lower in cases of intradialytic hypotension than that in none-cases of intradialytic hypertension（P0.01）;average heart rate of intradialysis,IDWG% were higher in cases of intradialytic hypotension than that in none-cases of intradialytic hypertension（P0.05）.The incidence of intradialytic hypotension was positively correlated with PreaMAP and IDWG%.Conclusion The incidence of intradialytic hypotension is 18.2% in our study.Intradialytic hypotension is prone to develop in patients with faster average heart rate of intradialysis,higher IDWG% and higher PreMAP.