透析患者中未控制高血压和已控制高血压的血流动力学分析  

Hemodynamics of dialysis patients with uncontrolled hypertension and controlled hypertension

作　　者：李红艳[1] 邵凤民[2] 王龙安[1] 

机构地区：[1]河南省人民医院急诊ICU,郑州450003 [2]河南省人民医院肾内科

出　　处：《中国实用医刊》2014年第1期4-7,共4页Chinese Journal of Practical Medicine

摘　　要：目的比较持续性非卧床腹膜透析（CAPD）患者中未控制高血压者和已控制高血压者的血流动力学，以探讨透析患者高血压的发生机制。方法选取115例CAPD患者为研究对象，根据血压水平分为两组：已控制的高血压组（CHT）：收缩压〈140mmHg（1mmHg=0．133kPa）或舒张压〈90mmHg，是否服用降压药均入选；未控制的高血压组（UHT）：收缩压≥140mmHg或舒张压1〉90mmHg，服用至少一种降压药。控制的高血压组又可根据服药状态分为两个亚组：CHTl组（收缩压〈140mmHg或舒张压〈90mmHg，不服用任何降压药）；CHT2组（收缩压〈140mmHg或舒张压〈90mmHg，服用至少一种降压药）。使用德国西门子超声仪G50测定血流动力学指标，使用自动脉搏波速度（PwV）分析仪测定PwV，使用多频生物电阻抗分析仪对患者的容量状态进行评估。不同组之间的各项指标比较用独立样本t检验或单因素方差分析。结果在未控制的高血压组，总外周阻力指数显著高于控制的高血压组，但心输出量指数比较差异无统计学意义。结论在CAPD患者中总外周阻力增高是高血压的主要原因。Objective To compare the hemodynamics of continuous ambulatory peritoneal dialy- sis （CAPD） patients with uncontrolled hypertension and controlled hypertension, and investigate the path- ogenic mechanisms of hypertension in dialysis patients. Methods One hundred and fifteen CAPD pa- tients were divided into two groups according to the level of blood pressure ： controlled hypertension group （CHT） ： systolic blood pressure（SBP） 〈 140 mm Hg（1 mm Hg =0. 133 kPa） or diastolic blood pres- sure（DBP） 〈90 mm Hg, with or without antihypertensive medications; uncontrolled hypertension group （UHT） ：SBP~〉 140 mm Hg or DBP~〉90 mm Hg, with at least one kind of antihypertensive medication. CHT were subdivided into two subgroups according to whether or not take antihypertensive medication： CHT1 （ SBP 〈 140 mm Hg or DBP 〈 90 mm Hg, without any antihypertensive medication）, CHT2 （ SBP 〈 140 mm Hg or DBP 〈 90 mm Hg, with at least one kind of antihypertensive medication）. Ultrasonic ma- chine GS0 was used to evaluate the hemodynamics. Carotid-femoral PWV was measured with a validated automatic device and was used as an index of large arterial stiffness. Multiple-frequency bioelectrical im- pedance analysis was used to record the values for extracellular water. Independent - samples t test and ANOVA were performed to analyze the difference of hemodynamics between different groups, to identify the factors which influence the pathogenesis of hypertension in patients with CAPD. Results In uncon- trolled hypertension group, TPRI was significantly higher than that in controlled hypertension group, but there was no significant difference in CI between them. Conclusions Increased TPR is the main reason of hypertension in patients with CAPD.

关 键 词：持续非卧床腹膜透析 高血压 总外周阻力 心输出量 血流动力学 

分 类 号：R544.1[医药卫生—心血管疾病]