老年血液透析患者干体质量下降与顽固性高血压关系研究  

Relationship between dry weight reduction and resistant hypertension in the elderly maintenance hemodialysis patients

作　　者：张冬[1] 孙雪峰[1] 朱晗玉[1] 陈香美[1] 

机构地区：[1]中国人民解放军总医院肾病科中国人民解放军肾脏病中心暨重点实验室,北京市100853

出　　处：《中华实用诊断与治疗杂志》2011年第5期424-426,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家973项目(2007CB507400);国家自然科学基金面上项目(30871171);全军医学科研"十一五"专项基金(08Z034)

摘　　要：目的：探讨老年维持性血液透析患者干体质量变化与顽固性高血压的关系。方法：行维持性血液透析老年患者12例,透析前坐位血压均〉140/90 mm Hg,至少服用≥3种降压药。根据患者血压变化逐渐降低干体质量,直至透析前坐位血压〈140/90 mm Hg,服用1种降压药或患者1周内连续2次透析过程中出现低血压或肌肉抽搐。患者均行常规血液检查、透析充分性评估、X线胸片、心脏超声及下腔静脉超声检查,并每3个月复查上述检查项目。结果：12例患者中10例血压达到目标值,2例因在透析中反复出现肌肉抽搐症状而停止降低干体质量。10例患者中位干体质量下降1.1（0.3~1.5）kg;研究结束时干体质量、收缩压、平均动脉压、下腔静脉直径及心胸比均较研究开始时下降（P〈0.05）;血压达到目标值时间为14~44（28.33±8.78）周。结论：降低透析患者干体质量可改善患者高血压水平,干体质量过高增加1 kg即可导致老年患者顽固性高血压的发生。Objective To investigate the relationship between the change of dry weight and refractory hypertension in the elderly maintenance hemodialysis patients.Methods Twelve elderly patients with refractory hypertension who had undergone hemodialysis for more than one year were recruited and studied.The sitting blood pressure before hemodialysis was higher than 140/90 mm Hg and at least 3 kinds of depressors were admitted.The dry weight decreased by degrees with the level of blood pressure until the sitting blood pressure was lower than 140/90 mm Hg,and one kind of depressors was admitted,or hypotension or spasticity of muscle happened twice during hemodialysis in a week.The hemoglobin,albumin,triacylglycerol and cholesterol levels were determined.The hemodialysis adequacy was evaluated.All of patients received the routine blood test,chest X-ray,echocardiography and angiography,and were reexamined every three months.Results The blood pressure was lower than 140/90 mm Hg in 10 patients.The median dry weight decreased by 1.1 kg in 10 patients.The systolic pressure,mean arterial pressure,the diameter of inferior vena cava and cardiothoracic ratio decreased obviously at the end of the study.The average time of getting goal blood pressure was from 14 to 44（28.33±8.78） weeks.The other two patients were stopped the dry weight decrease because of spasticity during hemodialysis.Conclusion The decrease of dry weight can relieve hypertension in hemodialysis.An overestimation of 1 kg of dry weight in elderly patients may lead to the occurrence of refractory hypertension.

关 键 词：维持性血液透析 干体质量 高血压 

分 类 号：R459.5[医药卫生—治疗学]