腹膜透析患者的总外周阻力对血压与容量关系的影响  

Peripheral resistance affects the relationship between volume status and blood pressure in peritoneal dialysis patients

作　　者：陈慧敏[1] 程李涛[1] 田俊萍[1] 唐利军[1] 顾玥[1] 杜凤和[2] 汪涛[1] 

机构地区：[1]北京大学第三医院肾内科,100083 [2]首都医科大学天坛医院心内科

出　　处：《中华肾脏病杂志》2008年第2期98-102,共5页Chinese Journal of Nephrology

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：目的研究腹膜透析（PD）患者中高血压与正常血压患者容量状态发生重叠的血流动力学机制。方法选取51例PD患者，采用生物电阻抗方法评估患者的细胞外液（ECW）、细胞内液（ICW）、总体水（TBW）水平，并通过身高标化后得出NECW。根据不同性别组NECW的平均水平定义为正常容量状态组（NV组，NECW≤平均水平）及高容量状态组（HV组，NECW〉平均水平）。再根据容量和血压将患者分成4组：正常血压合并正常容量组（NT-NV）、正常血压合并高容量组（NT-HV）、高血压合并正常容量组（HT-NV）和高血压合并高容量组（HT-HV）。超声心动图观测患者的每博输出量（SV）、心输出量（CO）及总外周阻力（TPR），并以体表面积校正，计算出相对应的指数SI、CI和TPRI。结果高容量状态组的ECW、ICW、TBW均明显高于正常容量组。HT-NV组TPR、TPRI水平明显高于NT-HV组[分别为（219，4±47．4）比（168．8＋54．6）Pa·s·cm^-3；（148．8±29．5）比（99，1±36．2）Pa·s·cm^-1，均P〈0．01]，同时也显著高于其他2组（P〈0．05）。而NT-HV组SV、SI、CO及CI与NT-NV组、HT-NV组差异无统计学意义。但HT-NV组SV及CO明显低于HT-HV组[SV：（58．3±8．4）ml比（75．6±21．9）ml；CO2（4．03±0．70）ml／m^2比（5．18±1．46）ml／m^2；均P〈0．05]。结论PD患者中高血压与正常血压患者容量状况的重叠与TPR及TPRI的差异有关。正常血压合并高容量状态的患者存在低TPR和TPRI，而高血压合并正常容量状态的患者则存在高TPR和TPRI。Objective To explore the hemodynamic mechanism in the relation between volume status and blood pressure in peritoneal dialysis patients. Methods Fifty-one peritoneal dialysis patients were enrolled in this study. ECW, ICW and TBW were assessed by bioimpedance analysis and NECW was calculated after individual height in meters was taken into account. The mean value of NECW in each gender was used to define normal volume （NV： ≤mean value） or high volume status （HV： 〉mean value）. All patients were thus divided into four groups： normotension with NV （NT-NV）, normotension with HV （NT-HV）, hypertension with NV （HT-NV） and hypertension with HV （HT-HV）. The stroke volume （SV）, cardiac output （CO） and total peripheral resistance （TPR） were measured through echocardiograms and their respective indices（SI, CI and TPRI） were calculated. Results The ECW, ICW and TBW in the NT-HV group and HT-HV group were higher as compared to the NT-NV and HT-NV groups （P〈0.01）. The TPR [（219.4±47.4） Pa·s·cm^-3] and TPRI [（148.8±29.5） Pa·s·cm^-1] in the HT-NV group were also significantly higher as compared to the other three groups. The SV, SI, CO and CI in the NT-HV group were not significantly different from those of the NT-NV group and HT-NV group. However, the SV and CO in the HT-NV group were significantly lower than those of the HT-HV group [SV： （58.3±8.4） ml vs （75.6±21.9） ml; CO： （4.03±0.70） ml/m^2 vs （5.18±1.46） ml/m^2, both P〈0.05 1. Conclusions The overlap in volume status between normotensive and hypertensive peritoneal dialysis patients is related to the significant difference in TPR and TPRI, but not in SV, SI, CO and CI. The normotensive patients with high volume status are characterized by lower TPR or TPRI, while the hypertensive patients with normal volume status are characterized by higher TPR or TPRI.

关 键 词：腹膜透析 血管阻力 血压 血流动力学 血容量 

分 类 号：R692.5[医药卫生—泌尿科学]