综合治疗干预下维持性血液透析患者季节性血压变化的影响因素分析

Analysis of influence factors of seasonal blood pressure change in patients with maintenance hemodialysis under the comprehensive therapy intervention

目的探讨维持性血液透析高血压患者在综合治疗干预下血压季节性变化的影响因素,为此类患者的临床治疗提供依据。方法选取2015年1月~2016年6月分别在深圳市宝安区人民医院和深圳市福永人民医院进行门诊维持性血液透析治疗,且配合综合治疗干预的患者60例,对其进行家庭血压监测、个体化降压治疗、服药依从性教育、睡眠质量调查、容量控制教育、饮食中钠的摄入量和电话随访,收集患者夏季(6~8月)和冬季(12~次年2月)的降压药及促红细胞生成素使用情况、血压值、透析间期体重增长率、血红蛋白、肌酐、尿素氮等结果 ,并比较两个季节的上述指标。结果综合治疗干预后,患者夏季和冬季的透析前的收缩压分别是(137.7±12.31)、(143.5±14.78)mm Hg,舒张压分别是(83.52±10.75)、(87.2±11.31)mm Hg,差异有统计学意义(P<0.05)。夏季和冬季患者的肌酐、尿素氮检验结果差异无统计学意义(P>0.05)。多元线性回归分析结果显示,冬季IDWG(P=0.024)、接受EPO治疗(P=0.027)、睡眠时间差值(P=0.038)是季节性血压变化的相关影响因素。结论冬季血压升高受多种因素影响,其中IDWG是影响冬季血压升高的主要影响因素,接受EPO治疗、睡眠质量是相关影响因素,只有对维持性血液透析高血压患者进行综合治疗和干预,才能对其季节性高血压的控制提出有效治疗方案。

Objective To explore the influence factors of the seasonal blood pressure change in patients hypertension given with maintenance hemodialysis under the comprehensive therapy intervention to provide evidence for clinical treatment for the patients.Methods A total of 60 patients with maintenance hemodialysis treated in outpatient of People,s Hospital of Baoan District in Shenzhen City and Fuyong People,s Hospital of Baoan District in Shenzhen City and this patients were given comprehensive therapy intervention at the same time from January 2015 to June 2016 were selected.The patients were given home blood pressure monitoring,individualized antihypertensive treatment,medication compliance education,sleep quality survey,volume control education,dietary sodium intake and telephone following-up,and ntihypertensive drugs and erythropoietin（EPO） use,blood pressure value,the growth rate of body weight during dialysis period,hemoglobin,creatinine,urea nitrogen and other results in summer（6-8 months） and winter（12-next year of 2 months） in patients were collected,and the above-mentioned indexes between the two groups were compared.Results After comprehensive treatment,the systolic pressure for patients in summer and winter was（137.7±12.31） mm Hg and（143.5±14.78） mm Hg respectively,and the diastolic blood pressure was（83.52 ±10.75） mm Hg and（87.2±11.31）mm Hg respectively before dialysis,and the differences were statistically significant（P〈0.05）.There were no significant differences in the test results of creatinine and urea nitrogen between summer and winter（P〉0.05）.Multiple linear regression analysis showed that IDWG（P=0.024）,EPO treatment（P=0.027） and sleep time difference（P=0.038） were the influencing factors of seasonal change in blood pressure.Conclusion The occurrence of elevated blood pressure is influenced by many factors in winter,amog them,IDWG is the main factors affecting winter elevated blood pressure,and being treated with EPO and sleep quality are related influence factors,only the comprehensive treatment and intervention applied in patients with hypertension given with maintenance hemodialysis then the effective treatment plan is put forward for the control the seasonal hypertension.