老年腹膜透析患者血压昼夜变化的观察  

Circadian rhythm of blood pressure and its related factors in elderly peritoneal dialysis patients

作　　者：杨继红[1] 程李涛[1] 顾玥[1] 唐利军[1] 汪涛[1] 

机构地区：[1]北京大学第三医院肾内科,100083

出　　处：《中华老年医学杂志》2007年第12期908-911,共4页Chinese Journal of Geriatrics

基　　金：教育部长江学者奖励计划和教育部教育振兴行动计划专项基金（985工程）

摘　　要：目的观察老年腹膜透析患者杓型血压的检出率及影响因素。方法50例60岁以上稳定的维持性腹透患者,夜间收缩压较白天收缩压降低超过10%为杓型血压;检测血清白蛋白及血、透析液和尿液中的尿素氮和肌酐水平,计算透析充分性;生物阻抗分析体液分布的状况;ECOG和Karnofsky活动指数评价患者的活动能力。结果45例患者符合欧洲高血压学会指南的动态血压记录标准,即白天血压测量次数大于14次,夜间血压测量大于7次的。透析时间（27.6±24.8）个月,男女比为22/23,11例（24.4%）患者存在杓型血压（杓型血压组）,两组患者年龄、透析时间、平均体质指数、体表面积、降压药的剂量、ECOG和Karnofsky活动指数差异无统计学意义;杓型血压组女性患者、无糖尿病和血清白蛋白含量明显多于或高于无杓型血压组[分别为9例（81.8%）和14例（41.2%）、11例（100%）和20例（58.8%）、（38.2±3.04）和（35.9±2.89）g/L],差异均有统计学意义（P〈0.05）;细胞外液、细胞内液、实际体质标准化的细胞外液、细胞外液和细胞内液与总体水的比值无杓型血压组明显高于杓型血压组,差异均有统计学意义（P〈0.05）。结论老年腹膜透析患者杓型血压以女性、无糖尿病患者居多,杓型血压的形成可能与容量负荷、营养、炎症和动脉硬化有关。Objective To evaluate the factors that affect dippers from ambulatory blood pressure monitoring （ABPM） in elderly peritoneal dialysis patients. Methods Fifty stable peritoneal dialysis （PD） patients were recruited into this cross-section study. The patients who had a decline of more than 10% in nighttime systolic blood pressure as compared with daytime systolic blood pressure were called dippers. At the same time, the serum albumin level, body composition and dialysis adequacy were measured. ECOG index and Karnofsky index were used to evaluate the physical activity of all the patients. Results Fifty patients were older than 60 years, among them, forty-five patients with average dialysis time of （27.6±24.8） months were able to tolerate the 14 daytime and 7 nighttime blood pressure measurements according to Europe Hypertension Society guidelines. Eleven patients （24. 4%） were in dipper and 34 patients were in non dipper. The age, gender, duration of PD treatment, residual renal Kt/V and peritoneal Kt/V, dose of antihypertensive drugs, mean systolic and diastolic blood pressure were not significantly differed between dippers and non-dippers. Dippers were common in female （9 cases, 81.80/00 vs. 14 cases, 41.2%） and non diabetes mellitus patients （11 cases, 100% vs. 20 cases, 58. 8%） than non-dippers. The extracellular water（ECW）, intracellular water, total body water, nECW, E/T and E/I were significantly lower in dippers than those in nondippers, serum albumin level was higher in dippers than in non-dippers（（38. 2±3.04）g/L vs. （35.9± 2.89）g/L, all P〈0. 05）. Conclusions Non-dippers are common in elderly PD patients, only 24. 4% patients are in dipper. In elderly patients, dipping may be associated with volume status, nutritional status, inflammatory status, being female and not having diabetes mellitus.

关 键 词：血压检测 便携式 腹膜透析 高血压 

分 类 号：R686[医药卫生—骨科学]