血液透析患者血压波动规律研究

A study on variation of blood pressure in maintenance hemodiaiysis patients

目的了解维持性血液透析（MHD）患者的血压波动规律及透析前高血压、透析中高血压、透-斤中低血压的发病情况。方法共纳入规律血液透析6个月以上患者72例，其中男性39例（54．17％），女性13例，年龄29-82（64．38＋13．28）岁，透析龄0．5～20．0（4．12＋4．28）年，均应用贝朗Dialog＋透析机、LOPS18聚砜莫透析器、碳酸盐透析液治疗。4周内共计942例次透析治疗。录入患者一般情况、每次超滤总量及透析前、垂析中第1、2、3小时及透析后血压。结果MHD患者超滤量为0．5-5．2（3．00±0．85）L，有615例次透析前收高压（SBP）≥140mmHg，约占总计942例次的65．29％。波动规律为：透析前SBP较高为（150．35＋23．73）mmHg，垂析中血压降低，透析后血压再次升高为（146．15±26．62）mmHg，但低于透析前（P〈0．01）。透析中高血压患旨发病规律为：透析前SBP低于非透析高血压患者（P〈0.01），透析第1小时血压下降，自第2小时起血压逐昕升高（P〈0．01），回血下机后血压显著升高（P〈0．01）。透析中低血压发作53例次，约占总例次的5．63％。吉论MHD患者高血压发病率高，控制率低。随着超滤量的增加，SBP逐渐下降，回血下机后，血压再次上．十，但仍低于透析前血压。超滤抵抗是透析中高血压的显著特点。

Objective To investigate the variation of blood pressure （BP） in maintenance hemodialysis （MHD） patients. And to understand the prevalence of hypertension, intradialysis hypertension and hypotension in MHD patients. Methods 72 patients （39 men, 33 women） who werentreated with hemodialysis for at least six months were enrolled in this study. Average age was 29-82 （64.38＋13.28） years, average history of dialysis was 0.5-20.0 （4.12±4.28）years. They were all treated with B. Bran dialog＋machine, LOPS18 poly-sulfone membrane dialyzer and carbonate dialyzate. There were 942 dialysis sessions in 4 weeks. The data of demographics, ultrafihra- tion kilos, predialysis blood pressure, first, second and third hour of intradialysis blood pressure and postdialysis blood pressure were documented. Results 615 of the 942 eases （65.29%） had a predialysis systolic blood pres- sure （SBP） of ≥140 mm Hg. As a whole, the predialysis SBP （150.35±23.73）mm Hg was high. And then SBP lowered along with dialysis process. After treatment, the postdialysis SBP （146.15±26.62）mm Hg rose once again, but it was lower than predialysis SBP（P〈0.01 ）. Intradialysis hypertension patients＇ predialysis SBP was lower than that of non-intradialysis hypertension patients （139.86：t：17.15 vs 153.78±24.49, P〈0.01）. In dialytic treatment, these patients＂ first hour SBP were lower than predialysis SBP （P〈0.01）, then, the SBP of the second and third hour rose gradually, postdialysis SBP raised obviously （165.96±19.66, P〈0.01 ）. Episodes of symptomatic hypoten- sion happened in 53 cases （5.63%）. Conclusion Prevalence of hypertension was high in MHD patients and con- trol rate was low. The SBP decrease was related with the amount of water ultrafihered. Ultrafiltration resistance was a obvious feature of intradialysis hypertension.