应用生物电阻抗法评估维持性血液透析患者透析不同时间点血压与体液分布的关系

The relationship between blood pressure and body fluid distribution measured by multi-frequency bioelectrical impedance at several time points during dialysis sessions in maintenance hemodialysis patients

目的应用多频生物电阻抗方法测量维持性血液透析(maintenance hemodialysis,MHD)患者透析前后体液的情况并与透析不同时间点血压进行比较,来探讨透析各时间点血压的意义。方法应用人体成分分析仪测定74例透析患者透析前后体内液体分布,同时记录透析前后不同时点血压的数值。应用Spearman相关分析,分析血压和体液分布的关系。结果 (1)透析前诊室收缩压最高,之后逐渐降低,透析3h血压最低。透析结束30min后收缩压升高,具体数值介于透析0h和透析1h之间;(2)总体水含量(total body water,TBW)(r=0.248,P=0.033)、细胞外液(extracellular water,ECW)(r=0.251,P=0.031)、细胞内液(Intracellular water,ICW)(r=0.233,P=0.046)和水负荷(overhydration,OH)(r=0.233,P=0.046)与透析2h的收缩压存在明显的相关性;透析前TBW(r=0.305,P=0.008)、ECW(r=0.244,P=0.036)、ICW(r=0.265,P=0.023)和OH值(r=0.218,P=0.023)与透析后30min的舒张压存在明显的相关性;透析前TBW、ECW、ICW和OH值与诊室血压、平卧5min血压、透析0、1h血压没有明显的相关性,与透析第2h舒张压没有明显的相关性。(3)透析后TBW(r=0.286,P=0.014)、ECW(r=0.283,P=0.015)、ICW(r=0.239,P=0.040)和OH值(r=0.284,P=0.014)与透析后30min舒张压存在明显的相关性;透析后TBW(r=0.230,P=0.049)、ECW(r=0.240,P=0.039)和OH值(r=0.380,P=0.001)与透析后30min的收缩压存在明显的相关性;透析后TBW(r=0.321,P=0.005)、ECW(r=0.287,P=0.013)和ICW(r=0.264,P=0.023)与透析2h收缩压存在明显的相关性。结论 (1)使用透析前诊室血压、平卧5min以及透析0h的血压来判断透析患者的容量负荷误差较大。(2)应该更加关注透析2h的血压情况,以便更加及时、准确地调节超滤。(3)透析后30min的血压可以更好的反应患者的容量负荷。

Objective To explore the significance of blood pressure at specific time points during dialysis sessions in maintenance hemodialysis （MHD） patients, we compared the body fluid distribution measured by multi-frequency bio-electrical impedance before and after dialysis with the blood pressure at several time points during dialysis sessions. Methods The human body composition analyzer was used to record body fluid distribution before and after dialysis in 74 MHD patients. Blood pressure was measured at several time points including clinic blood pressure, blood pressure after recumbent position for 5 minutes, after 0 minutes, one hour and 2 hours in dialysis sessions, and after completion of dialysis for 30 minutes. The relationship between blood pressure values and body fluid distribution was analyzed by using Spearman correlation method. Results QSystolic blood pressure （SBP） was the highest before dialysis, and reduced gradually to the lowest after 3 hours in dialysis sessions. SBP then increased after completion of dialysis for 30 minutes, when the blood pressure value ranged between the values after 0 hour and one hour in dialysis sessions. （2）Before dialysis, TBW, ECW, ICW, and overhydration （OH） values were significantly correlated with the SBP after 2 hour in dialysis sessions （r=0.248, P=- 0.033 for TBW; r=0.251, P=0.031 for ECW; r=0.233, P=0.046 for ICW; r= 0.233, P=-0.046 for OH）, were significantly correlated with the diastolic pressure after the completion of dialysis for 30 minutes （1=0.305, P=-0.008 for TBW; r=0.244, P=-0.036 for ECW; r=0.265, P=- 0.023 for ICW; r= 0.218,P=-0.023 for OH）, but had no correlations with the clinic blood pressure, blood pressure after recumbent position for 5 minutes, dialysis for 0 minutes and one hour, and the diastolic pressure after 2 hours in dialysis sessions （P〉0.05）. （3）After dialysis, TBW, ECW, ICW and OH were significantly correlated with the diastolic pressure after the completion of dialysis for 30 minutes （2=0.286, P=0.014 for TBW; 2=0.283, P=-0.015 for ECW; 2=0.239,P-0.040 for ICW; 2=0.284,P=0.014 for OH）; TBW, ECW and OH were significantly correlated with the SBP after the completion of dialysis for 30 minutes （2=0.230, P=-0.049 for TBW; r=0.240, P=0.039 for ECW; r=0.380, P=0.001 for OH）; TBW, ECW and ICW were significantly correlated with the SBP after 2 hour in dialysis sessions （2=0.321, P=0.005 for TBW;r=0.287, P=0.013 for ECW; 2=0.264, P=0.264 for ICW）. Conclusions （1）It will be misjudged if only the clinic blood pressure, blood pressure after recumbent position for 5 minutes, and the blood pressure just before dialysis sessions are used to determine the capacity load. （2）The blood pressure after 2 hours in dialysis sessions should be closely monitored, and is helpful for timely and accurate adjustment of ultrafiltration volume. （3）The blood pressure after completion of dialysis for 30 minutes will be better to reflect the patients＇ capacity load.