终末期糖尿病肾病患者行维持性血液透析发生低血压与高血压的因素分析

摘要

Objective To analyze the factors for hypotension and hypertension during maintenance hemodialysis for patients with terminal stage of diabetic nephropathy. Methods A total of 134 patients receiving hemodialysis were divided by their dialysis duration into <1 year group with 30 cases, 1~3 years group with 35 cases, 3~5 years group with 32 cases, and>5 years group with 37 cases. They were also divided into high ultrafiltration group with 70 cases and low ultrafiltration group with 64 cases, according to their ultrafiltration velocity. Results ①In the<1 year group, hypotension occurred in 4 cases (13.3%) and hypertension was in 8 cases (26.7%). The 1~3 years group had hypotension cases as 8 (28.9%) and hypertension cases as 7 (20.0%). The 3~5 years group had hypotension cases as 10 (31.3%) and hypertension cases as 4 (12.5%). Hypotension occurred in15 cases (40.5%) in the>5 years group, and its hypertension cases was 4 (10.8%). The difference between the groups had statistical significance (P<0.05).②The hypotension cases in the high ultrafiltration group was as 22 (31.4%), and that in the low ultrafiltration group was 11 (17.2%). The difference between the groups had statistical significance (P<0.05). In multivariable Logistic regression model, there was a significant correlation between dialysis duration and hypertension and hypotension occurred during hemodialysis, and the ultrafiltration velocity was correlated with hypotension occurred during hemodialysis. There was no correlation between hypertension and hypotension in hemodialysis and gender, age, blood flow volume, and dialyzer flux. Conclusion Due to the increasing dialysis duration, the hypotension rate is increased year by year, while the hypertension rate is decreased. Ultrafiltration velocity has correlation with hypotension in dialysis, and when the velocity ≤ 10 ml/(kg·h), it can reduce hypotension rate during dialysis.%目的：分析终末期糖尿病肾病患者行维持性血液透析引起低血压与高血压的因素。方法134例进行透析的患者，依照透析年限，分为<1年组30例、1~3年组35例、3~5年组32例和>5年组37例；根据超滤速度分为高超滤组70例和低超滤组64例。结果①<1年组中引起低血压4例(13.3%)，高血压8例(26.7%)；1~3年组引起低血压8例(28.9%)，高血压7例(20.0%)；3~5年组中引起低血压10例(31.3%)，高血压4例(12.5%)；>5年组中引起低血压15例(40.5%)，高血压4例(10.8%)。组间差异具有统计学意义(P<0.05)。②高超滤组引起低血压22例(31.4%)，低超滤组低血压11例(17.2%)。组间差异具有统计学意义(P<0.05)。在多变量Logistic回归模型中，透析年限与血液透析时发生高血压和低血压相关性显著，超滤速度与血液透析时发生低血压相关性显著，而性别、年龄、血流量、透析器通量等因素与血液透析时发生低血压或高血压没有相关性。结论由于透析年限增加，透析时低血压几率逐年升高，高血压几率却逐年下降；超滤速度与透析中低血压有相关性，超滤速度≤10 ml/(kg·h)时可降低透析时低血压几率。