糖尿病肾病终末期患者血液透析出现低血压的影响因素分析

Analysis of influencing factors of low blood pressure in hemodialysis patients with end stage of diabetic nephropathy

目的分析糖尿病肾病终末期患者血液透析出现低血压的影响因素。方法选取59例糖尿病肾病中晚期且接受维持性血液透析患者为研究对象，将患者资料进行整理，比较不同透析模式、血流量、透析器、个体化超滤速度下低血压发生频率，并分析在透析过程中发生低血压的影响因素。结果经多变量回归分析得到，患者性别、透析模式、透析器的选择和血流量与透析过程中发生低血压无关，而患者年龄、血红蛋白、血清白蛋白、心功能和个体化超滤速度与糖尿病肾病患者发生低血压存在相关性。个体化超滤速度≤10mL·kg^-1·min^-1与个体超滤速度〉10mL．kg^-1·min^-1的患者低血压发生率分别为18．9％与25．9％，差异有统计学意义（χ^2=7．102，P〈0．05）。结论糖尿病肾病患者在透析过程中，主要通过控制个体超滤速度可以有效减少血液透析过程中发生低血压频率，患者可以提高血液透析的耐受性。

Objective To explore the influencing factors of hypotension in hemodialysis patients with end stage of diabetic nephropathy. Methods 106 patients of advanced diabetic nephropathy who received maintenance hemodialysis were selected in the present study. According to the patients＂ condition needs, chose different dialysis modes,dialyzers, dialysis blood flow and ultrafiltration rate, compared the frequency of occurrence of hypotension during treatment. Results By multivariate regression analysis, gender, dialysis mode, dialysis and blood flow had no correlation with hypotension during dialysis. The age, hemoglobin, serum albumin, cardiac function and individual uhrafiltration rate were correlated with the incidenee：of hypotension in patients with diabetic nephropathy. Individual- ized ultrafiltration rate was less than or equal to 10 mL·kg^-1·min^-1 and individual ultrafiltration rate was up to 10 mL·kg^-1·min^-1,the incidence rates of hypotension were 18.9% and 25.9% ,the difference was statistically significant （χ^2 = 7. 102, P 〈 0, 05 ）. Conclusion Diabetic nephropathy patients during dialysis, uhrafiltration rate control individuals can effectively reduce the frequency of occurrence of hypotension during dialysis, hemodialysis patients may improve tolerability.