维持性血液透析患者透析过程相关高血压的影响因素

Influence factors of intradialytic hypertension in maintenance hemodialysis patients

目的探讨维持性血液透析患者透析过程相关高血压(IDH)的影响因素。方法入选2010-01-01-2010-12-31福建医科大学附属第一医院肾内科行维持性血液透析的终末期肾脏病患者53例(1年内共进行6890次血液透析),探讨透析过程患者的尿素清除指数(Kt/v)、透析间期体质量增长量(IDWG)、超滤率、甲状旁腺素、促红细胞生成素、平均住院次数、心脑血管疾病并发症发生率等与IDH的关系。根据IDH发生次数分为≥3次(A组,n=19)和≤2次(B组,n=34)。结果与B组比较,A组的透析频率[(2.1±0.3)比(3.0±0.7)次/周]、Kt/v[(0.8±0.1)比(1.3±0.1)]、血红蛋白[(96.4±3.8)比(102.1±2.1)g/L]均较低(P<0.05),而透析前后收缩压和舒张压差值[收缩压(26.4±11.0)比(8.2±6.8)mmHg;舒张压(10.2±4.8)比(4.0±1.2)mmHg]、IDWG[(3.8±1.2)比(2.1±0.9)kg]、超滤率[(14.2±0.2)比(9.1±0.4)mL/(h·kg)]、甲状旁腺素[(564.5±68.7)比(365.9±46.9)ng/L]、促红细胞生成素治疗比例(100%比85.3%)及治疗剂量[(10000±1546)比(8856±1287)U/W]、平均住院次数[(0.7±0.2)比(0.3±0.3)次/年]、心脑血管疾病并发症发生率(64%比12%)均较高(P<0.05)。就单次透析而言,与发生IDH比较,未发生IDH患者的IDWG、超滤率、透析期间平均心率、透析前平均动脉压均较低(P<0.05)。多因素Logistic回归分析显示,IDH影响因素分别为IDWG、透析频率、透析期间平均心率、透析前平均动脉压、超滤率。结论 IDH与IDWG、透析前平均动脉压、透析期间平均心率、透析频率、超滤率相关。

Objective To investigate the influence factors of intradialytic hypertension（IDH） in maintenance hemodi- alysis patients. Methods A total of fifty three patients with end-stage kidney disease, who underwent hemodialy- sis （6890 times a year） in the First Affiliated Hospital of Fujian Medical from January 1, 2010 to December 31, 2010, were enrolled. The correlation between IDH and the outcome measures, including urea clearance index （Kt/v）, interdialytic weight gain （IDWG）, uhrafihration （UF） rate, intact parathyroid hormone （iPTH ）, erythropoietin, average hospitalization rate, incidence of complications of cardiovascular and cerebrovascular disease, in dialysis were investigated. According the occurrences of IDH, they were divided into group A （≥3 times, n=19） and group B （≤2 times, n = 34 ）. Results Compared with those of group B, the dialysis frequency [,（ 2. ± 0.3 ） vs （ 3.0 ± 0.7）times/week], Kt/v [（0.8±0.1） vs （1.3±0.1）], hemoglobin（HGB） [（96.4±3.8） vs （102.1±2. 1） g/L] of group A were lower （P〈0.05）. While blood pressure change after dialysis variations [systolic blood pressure： （26.4±11.0） vs （8.2±6.8） ; diastolic blood pressure： （10.2±4.8） vs （4.04-1.2）mm Hg], IDWG [（3.8±1.2） vs （2.1±0.9）kg], UF rate [,（15.3±0.2） vs （9.1±0.4）mL/（h . kg）], iPTH [（564.5±68.7） vs （365.9± 46.9）ng/L], the treatment rate （100% vs 87% ） and mean doses [（10 000±1546） vs （8856±1287）U/W] of eryth- ropoietin （ EPO）, average hospitalization rate [ （0.7± 0.2 ） vs （0.3 ± 0.3 ） times/year], relative cardiovascular and cerebrovascular complications incidence （64 %vs 12 %） were all higher in group A （P〈0.05）. In terms of single dialysis, the IDWG, uhrafiltration rate, average heart rate of intradialysis, pre-dialysis mean arterial blood pressure（PreMAP） of the cases without IDH were lower than those with IDH （P〈0.05）. Multivariate Losgistic regres- sion analysis revealed that IDWG, dialysis frequency, average heart rate of intradialysis, PreMAP, ultrafiltration rate were influence factors of IDH. Conclusions IDH is correlated with IDWG, PreMAP, average heart rate of in- tradialysis, and dialysis adequacy.