维持性血液透析患者体液分布与透析相关低血压的关系

A study on the relationship between body fluid distribution and intradailytic hypotension among maintenance hemodialysis patients

目的 分析维持性血液透析（maintenance hemodialysis,MHD）患者透析前体液分布情况与透析相关性低血压（intradialytic-hypotension,IDH）发生的关系,为透析超滤方案制定提供依据.方法 应用生物电阻抗测量42例符合研究条件患者620次血液透析过程体液分布情况以及记录血压变化、低血压发生情况,根据是否出现透析相关性低血压分为低血压组和非低血压组,比较2组透析前体液分布、血压变化等情况,应用Logistic回归分析体液分布指标与透析相关性低血压发生的相关性. 结果 620次血液透析过程共出现143次透析相关性低血压,发生率为23.06％,多因素Logistic回归分析提示透析前细胞外液、透析前收缩压、总体水/体质量、千克体质量总体液超滤速度与透析相关低血压发生相关（P＜0.05）.进一步的受试者工作曲线（ROC）分析发现,千克体质量总体液超滤速度判断透析相关性低血压发生的曲线下面积（AUC）为0.680 （95％ CI：0.632-0.727,P=0,000）,以界值0.198ml/kg.min预测透析相关性低血压敏感度为89.5％,特异度为60.5％. 结论 高超滤速度、透析前高收缩压、低细胞外液、低总体水/体质量比值是透析相关性低血压体液相关的危险因素,千克体质量总体液超滤速度可作为透析相关性低血压的预测因子.

Objective To analysis the relationship between body fluid distribution before hemodialysis and intradialytic hypotension （IDH） among maintenance hemodialysis （MHD） patients, and to provide clinical basis for the prevention of IDH. Method Body fluid distribution before hemodialysis was measured by bioimpedance electrical spectroscopy. Changes of blood pressure during hemodialysis were recorded in 620 hemodialysis sessions in a period of 6 weeks from 42 MHD patients, and then the 620 hemodialysis sessions were divided into hypotension group or non-hypotension group. Body fluid distribution and blood pressure changes were compared between the two groups. Logistic regression was use to assess the relationship between body fluid distribution and IDH. Result A total of 143 IDH events occurred in the 620 hemodialysis sessions （23.06%）. Logistic regression revealed that extracellular fluid, systolic pressure, total water/body weight ratio （TW/W） before hemodialysis and ultrafiltration speed （UFS） calculated by TW removed （ml/kg. min） were the risk factors of IDH （P〈0.05）. ROC curve was used to predict IDH by UFS; the area under the ROC curve （AUC） was 0.680 （95% CI： 0.632-0.727, P〈0.001）, and the sensitivity and specificity for IDH was 89.5% and 60.5%, respectively, when the cutoff value of UFS was set at 0.198 ml/kg.min. Conclusion Higher systolic pressure, lower extracellular fuid, and lower total water/weight ratio before hemodialysis, and higher ultrafiltration speed were the risk factors for IDH. Ultrafiltration speed calculated by TW removed can be used for predicting IDH.