维持性血液透析与腹膜透析患者血压变异性比较

A comparative study on variability of blood pressure in patients treated by maintenance hemodialysis or continuous peritoneal dialysis

目的对比维持性血液透析(MHD)和连续性非卧床腹膜透析(CAPD)患者血压变异性,观察不同透析方式血压变化的特点。方法选择MHD和CAPD治疗的非糖尿病尿毒症患者各30例,对MHD患者进行非透析期间的44 h动态血压(ABP)检测,对CAPD患者进行24 h ABP检测。分析MHD患者透析日与非透析日ABP特点,并与CAPD患者ABP参数进行对比,分析尿毒症患者不同治疗模式对于血压变异性的影响。结果 MHD患者非透析日血压明显高于CAPD患者,收缩血压(SBP)平均148.9±20.6 mmHg对129.9±16.4 mmHg,差异有显著性(P<0.001);舒张血压(DBP)平均89.9±12.5 mmHg对82.9±11.5 mmHg,差异具有显著性(P=0.028);MHD患者透析日杓型血压5例(16.7%),明显高于CAPD患者(0例),差异有显著性(P=0.029);MHD与CAPD患者血压标准差的均值(SD)和SBP变异系数(CV)的差异无显著性,但MHD患者非透析日DBP的SD明显高于透析日,10.4±2.9对12.5±5.0,差异有显著性(P=0.031)。结论 MHD患者非透析日血压较CAPD患者高,部分MHD患者透析后可恢复"杓型"节律,MHD患者非透析日血压变异性大。

Objective To explore the difference in variability of blood pressure（BPV） in patients treated by maintenance hemodialysis（MHD） compared with continuous peritoneal dialysis（CAPD）.Methods Thirty patients with MHD and thirty patients with CAPD in this hospital were recruited for this cross-sectional study.The ambulatory blood pressure（ABP） monitoring was proceeded in patients with MHD for 44 hours and in patients with CAPD for 24hours.The mean value of systolic blood pressure（SBP）,diastolic blood pressure（DBP）,the declining percentage of nocturnal SBP,the mean value of standard deviation（SD） and coefficient of variation（CV） were compared between patients with MHD and CAPD.These parameters were also compared between dialysis day and non-dialysis day in patients with MHD.Results The mean value of blood pressure of patients with MHD in non-dialysis day was significantly higher than that of patients with CAPD（SBP,148.9 ± 20.6 mmHg vs.129.9 ± 16.4 mmHg,P 0.001;DBP,89.9 ± 12.5 mmHg vs.82.9 ± 11.5 mmHg,P = 0.028）.The cases of dipper pattern blood pressure in patients with MHD in dialysis day were much higher than those in patients with CAPD（5 /30 vs.0,P = 0.029）.There was no significant difference on both SD and CV between patients with MHD or CAPD.However,the SD level of DBP in non-dialysis day was larger than that in dialysis day,10.4 ± 2.9 vs.12.5 ± 5.0,P = 0.031.Conclusion The blood pressure of patients with MHD in non-dialysis day is higher than that of patients with CAPD.There are dipper pattern blood pressure in some patients with MHD after hemodialysis.The variability of blood pressure in patients with MHD is larger in non-dialysis day.