慢性肾病维持性血液透析患者的血压变异危险因素分析

摘要

目的：评估慢性肾病维持性血液透析（MHD）患者透析过程中血压变异性（BPV）情况，探讨影响 MHD过程中 BPV增加的相关危险因素。方法对该院112例 MHD患者进行回顾性分析。记录血液透析过程中所有血压值，分析患者透析中是否发生心脑血管事件的 BPV 情况。结果患者透析过程中收缩压 BPV 值为（12．19±3．74）％，舒张压 BPV 值为（11．90±2．49）％。其中出现心血管事件43例，脑血管事件5例，发生心脑血管事件患者的收缩压 BPV值明显高于未发生心脑血管事件的患者（P＜0．05），而舒张压BPV值在两组间差异无统计学意义（P＞0．05）；将透析中收缩压 BPV作为应变量进行多元回归分析，结果显示患者年龄、透析间期体质量增长率、透析前收缩压及血红蛋白水平是透析中收缩压BPV的独立影响因素。将透析中舒张压BPV作为应变量进行多元回归分析，结果显示透析间期体质量增长率、平均脱水量是透析中舒张压 BPV的独立影响因素。结论高龄、透析前高收缩压、透析间期体质量增长率增加、血红蛋白水平降低为 MHD患者透析中收缩压 BPV升高的独立危险因素。%Objective To evaluate blood pressure variability(BPV)during the dialysis process in the patients with chronic kid-ney disease on maintenance hemodialysis(MHD),and to investigate the correlated factors influencing BPV increase during the MHD process.Methods 112 patients with chronic nephrosis on MHD were analyzed retrospectively.All the blood pressure values during dialysis process were recorded and the BPV situations were analyzed.Results During the dialysis process,systolic BPV was (12.19±3.74)% and diastolic BPV was (11.90±2.49)%.43 cases of cardiovascular events and 5 cases of cerebrovascular events occurred,in which,systolic BPV in the patients with cardiocerebrovascular events was significantly higher than that in the patients without cardiocerebrovascular events (P<0.05),while diastolic BPV had no statistically significant difference between the two groups (P>0.05).The intradialytic systolic BPV was used as the variate for conducting the multivariable regression analysis.The results showed that age,systolic blood pressure and hemoblobin level before dialysis,interdialytic weight gain(IDWG)rate during dialysis were the independent influential factors for intradialytic systolic BPV.The intradialytic diastolic BPV was used as variate for conducting the muhivariable regression analysis.The analytic results showed that the IDWG rate and average dehydration vol-ume were the independent influential factors for intradialytic diastolic BPV.Conclusion Advanced age,high systolic pressure be-fore hemodialysis,IDWG rate increase and hemoglobin level decrease are the independent risk factors of intradialytic systolic BPV increase.