维持性血液透析患者透析期血压波动的危险因素及其对生存状况的影响

Risk Factors of Blood Pressure Fluctuation in Maintenance Hemodialysis Patients During Dialysis and its Impact on Survival Status

目的:观察维持性血液透析(MHD)患者透析期血压波动的状况,分析其危险因素及其对生存状况的影响。方法:从江苏省人民医院选取于2018年4月~2021年7月期间接受治疗的210例MHD患者。将患者根据△收缩压(SBP)的绝对值大小,分为血压低波动组(84例,△SBP的绝对值大小<10 mm Hg)和血压高波动组(126例,△SBP的绝对值大小≥10 mm Hg)。收集两组患者的一般资料和实验室资料,MHD患者血压波动的危险因素采用Logistic回归模型进行分析。以门诊复查或电话的形式随访1年,统计两组预后情况。结果:单因素结果显示,MHD患者透析期血压波动与透析龄、体质量指数(BMI)、收缩压(SBP)、舒张压(DBP)、磷(P)、白蛋白(ALB)、血红蛋白(Hb)、全段甲状旁腺激素(i PTH)、尿素清除指数(Kt/V)、超滤量有关(P<0.05)。而与年龄、性别、血肌酐(Scr)、尿素氮(BUN)、钙(Ca)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)无关(P>0.05)。多因素Logistic回归模型结果显示:透析龄越长、i PTH升高、Kt/V下降、P升高、BMI升高是导致MHD患者透析期血压波动的危险因素,ALB上升为保护因素(P<0.05)。两组患者1年生存率、死亡率组间对比无统计学差异(P>0.05)。结论:MHD患者透析期血压波动受到透析龄、i PTH、Kt/V、P、ALB、BMI变化的影响,MHD患者透析期血压波动均会导致患者发生死亡风险。

Objective: To observe the blood pressure fluctuation in maintenance hemodialysis(MHD) patients during dialysis, and to analyze its risk factors and its impact on survival status. Methods: 210 cases of MHD patients who received treatment from April 2018to July 2021 were selected from Jiangsu Provincial People’s Hospital.According to the absolute value of △ systolic blood pressure(SBP),the patients were divided into blood pressure low fluctuation group(84 cases, △SBP absolute value <10 mm Hg) and blood pressure high fluctuation group(126 cases, △SBP absolute value ≥10 mm Hg). The general data and laboratory data of the two groups of patients were collected. Univariate and multivariate Logistic regression models were used to analyze the risk factors of blood pressure fluctuation in MHD patients. The patients were followed up for 1 year in the form of outpatient review or telephone call, and the prognosis situation of the two groups was counted. Results: Univariate results showed that blood pressure fluctuation in MHD patients during dialysis was related to dialysis age, body mass index(BMI), systolic blood pressure(SBP), diastolic blood pressure(DBP), phosphorus(P), albumin(ALB), hemoglobin(Hb), total parathyroid hormone(i PTH), urea clearance index(Kt/V) and ultrafiltration volume(P<0.05). However,age, gender, serum creatinine(Scr), blood urea nitrogen(BUN), calcium(Ca), total cholesterol(TC), high density lipoprotein cholesterol(HDL-C) were not correlated(P>0.05). The results of multivariate Logistic regression model showed that the longer dialysis age,increased i PTH, decreased Kt/V, increased P, and increased BMI were the risk factors for blood pressure fluctuation in patients with MHD during dialysis, and the higher the ALB was the protective factor(P<0.05). There was no significant difference in 1-year survival rate and mortality between the two groups(P>0.05). Conclusion: The blood pressure fluctuation in MHD patients during dialysis is affected by the changes of dialysis age, i PTH, Kt/V, P, ALB and BMI. The blood pressure fluctuation in MHD patients during dialysis will lead to the risk of death of patients.