维持性血液透析患者透前血压变异性与症状困扰的相关性研究

Relationship Between Pre-dialysis Blood Pressure Variability and Symptom Disturbance in Maintenance Hemodialysis Patients

目的调查维持性血液透析(maintenance hemodialysis, MHD)患者透前血压变异性(blood pressure variability, BPV)及症状困扰现况,探讨透前BPV与症状困扰之间的相关性。方法以160例MHD患者作为研究对象,收集患者透前血压、体质量变化、超滤量、血肌酐等相关数据。采用一般情况调查表、症状困扰量表对患者进行调查,分析透前BPV与症状困扰间的相关性。结果 160例MHD患者根据收缩压变异性(systolic blood pressure variability, SBPV)的四分位数分成4组,4组患者在血清白蛋白、头晕、便秘、瘙痒、焦虑和易醒方面存在统计学差异(P<0.05),而在血肌酐、尿酸、钙、磷、镁、碱性磷酸酶、全段甲状旁腺素(intact parathyroid hormone, iPTH)方面无统计学差异(P>0.05)。MHD患者各症状困扰发生率为13.75%~83.75%,发生率最高的5项分别是疲乏、皮肤干燥、口干、瘙痒和入睡困难,症状困扰严重程度评分最高的5项是疲乏、皮肤干燥、口干、瘙痒和性欲减退。症状困扰程度总分与透前SBPV呈正相关(P<0.05)。结论 MHD患者透前BPV和症状困扰发生较常见,而且二者之间存在一定的相关性,应重视透前BPV及症状困扰,合理进行干预,提高患者生活质量。

Objective To investigate the pre-dialysis blood pressure variability(BPV) and symptom disturbance in maintenance hemodialysis(MHD) patients, and to explore the correlation between pre-dialysis BPV and symptom disturbance.Methods A total of 160 MHD patients were selected as the research subjects.The blood pressure, body mass change, ultrafiltration volume, serum creatinine and other related data of patients before dialysis were collected.The patients were investigated by general information questionnaire and symptom disturbance scale, and the correlation between pre-dialysis BPV and symptom disturbance was analyzed. Results A total of 160 MHD patients were divided into 4 groups according to the quartile levels of systolic blood pressure variability(SBPV).There were significant differences in serum albumin, dizziness, constipation, pruritus, anxiety and easy awakening among the 4 groups(P<0.05),but there were no significant differences in serum creatinine, uric acid, calcium, phosphorus, magnesium, alkaline phosphatase and intact parathyroid hormone(iPTH)(P>0.05).The incidence of symptom disturbance in MHD patients was 13.75%-83.75%, the 5 highest incidence rate were fatigue, dry skin, dry mouth, pruritus and difficulty falling asleep. The 5 items with the highest severity scores of symptoms were fatigue, dry skin, dry mouth, pruritus and decreased libido. The total score of symptom disturbance was positively correlated with pre-dialysis SBPV(P<0.05).Conclusion Pre-dialysis BPV and symptom disturbance are more common in MHD patients, and there is a correlation between the two. Attention should be paid to the change of pre-dialysis BPV and symptom disturbance, and reasonable intervention should be carried out to improve the quality of life of MHD patients.