维持性血液透析患者自主神经功能异常与透析中低血压的关系  

The correlation of autonomic dysfunction and intra-dialytic hypotension in maintenance hemodialysis patients

作　　者：徐静[1,2] 程叙扬[1] 金其庄[1] 曹立云[1] 刘莉[1] 左力[1] 

机构地区：[1]北京大学第一医院肾内科北京大学肾脏疾病研究所,北京100034 [2]北京大学首钢医院肾内科,北京100144

出　　处：《中国血液净化》2011年第11期594-598,共5页Chinese Journal of Blood Purification

摘　　要：目的以心率变异性(heart rate variability,HRV)为观察指标,分析维持性血液透析(maintenance hemodialysis,MHD)患者的自主神经功能异常与透析中低血压(intradialytic hypotension,IDH)的关系。方法在透析过程中同步监测患者的血压和动态心电图,依据是否发生IDH将60例患者分为2组(血压下降组和对照组),比较2组的HRV指标,其中LFn代表交感神经活性,HFn代表迷走神经活性,LF/HF代表2者之间的平衡状态。以发生IDH为结果变量,以性别、年龄、透析龄、原发病是否糖尿病、心脏指数、中心血容量占体质量百分比、超滤量占体质量百分比和透析前LFn为预测变量,建立Logistic回归模型分析LFn对IDH的预测价值。结果对照组在透析过程中LFn水平和LF/HF比值逐渐升高,且升高趋势稳定(LFn中位数:透析开始时65.47nu,210min时73.79nu,P=0.001;LF/HF中位数:开始时2.17,210min时3.98,P<0.001),HFn的水平则逐渐减低(HFn中位数:透析开始30.06nu,210min时19.43nu,P=0.002);而血压下降组的上述指标变化趋势不稳定,其中LFn在整个透析过程中都始终低于对照组。logistic回归模型显示,在校正了上述人口学特征和临床基础情况后,LFn对IDH的发生仍有预测价值,OR值为0.943(95%CI0.894～0.966)。结论维持性血液透析患者交感神经活性在透析过程不能随血容量的下降持续、稳定的增高,与IDH的发生有密切关系;透析前交感神经活性的基础水平减低是IDH的独立危险因素,表明自主神经功能异常是导致透析中低血压的重要原因之一。Objective To investigate the correlation between autonomic nervous system dysfunction and intra-dialytic hypotension （IDH） in maintenance hemodialysis （MHD） patients by analyzing the heart rate variability （HRV）. Methods Blood pressure changes were recorded and dynamic electrocardiography （Holter） was conducted in 60 MHD patients during a hemodialysis session. Patients were assigned into IDH group or control group. The difference in power spectra of HRV between the two groups was analyzed. The normalized low-frequency （LFn） component of HRV was assumed to be the index of sympathetic activity, and the normalized high-frequency （HFn） component to be the index of parasympathetic activity. The LF/HF ratio then indirectly represents the balance level between sympathetic and vagal activities. A logistic regression model was set up to analyze the value of LFn for the prediction of IDH, using IDH as the outcome variable, and parameters including sex, age, hemodialysis age, diabetes as the primary disease, cardiac index, central blood volume/body weigh ratio, ultrafiltration volume/body weight ratio and LFn before hemodialysis as the prediction variables. Results In control group, LFn and LF/HF ratio elevated continually and gradually in a dialysis session （The median of LFn was 65.47nu at the beginning of hemodialysis, 73.79nu after 210 minutes, P=0.001; The median of LF/HF ratio was 2.17 at the beginning, and 3.98 after 210 minutes, P 0.001）, whereas HFn reduced gradually （The median of HFn was 30.06nu at the beginning and 19.43nu after 210 minutes, P=0.002）. In IDH group, however, the above indexes changed inconsistently, and LFn was lower than that of control group in the entire hemodialysis session. Logistic regression model showed that LFn was a predictor for IDH （OR= 0.943, 95%CI=0.894～0.966） after adjustment by the above demographic characteristics and basic clinical situations. Conclusion In MHD patients, the presence of IDH may relate to the incapability of continuous and co

关 键 词：心率变异性 维持性血液透析 透析中低血压 

分 类 号：R318.16[医药卫生—生物医学工程]