维持性血液透析患者透析中血压变化与生存率的关系  

The relationship between changes of blood pressure during dialysis and mortality in maintenance hemodialysis patients

作　　者：蔡宏[1] 张伟明[1] 严玉澄[1] 陆任华[1] 庞慧华[1] 林星辉[1] 朱铭力[1] 方燕[1] 王咏梅[1] 倪兆慧[1] 钱家麒[1] 

机构地区：[1]上海交通大学医学院附属仁济医院肾内科,200127

出　　处：《中华肾脏病杂志》2014年第4期241-246,共6页Chinese Journal of Nephrology

摘　　要：目的探讨维持性血液透析（MHD）患者透析中血压变化和全因死亡、心血管病死亡之间的关系。方法收集2007年7月至2012年12月上海交通大学医学院附属仁济医院MHD患者一般情况、生化指标以及生存预后。评估血液透析过程中患者血压变化与死亡之间关系。结果364例患者年龄为（63．07±13．93）岁，中位透析龄为76．00（42．25，134．00）个月，随访时间为（54．86±19．84）个月，全因死亡患者85例，占人选人数的23．4％，心血管病死亡46例，占入选人数的12．6％。透前与透后收缩压差（ASBP）在7．08mmHg至14．25mmHg之间的患者发生全因死亡以及心血管死亡的危险度最低fOR分别为0．324和0．335，95％C1分别为（0．152，0．692）和（0．123，0．911），P值分别为0．004和0．0321。Kaplan—Meier分析显示透后血压升高大于0．25mmHg（ASBP〈-0．25mmHg）的患者其全因死亡、心血管病死亡均显著增加（P值分别为0．001和0．044）。多因素Logistic回归分析显示ASBP〈-0．25mmHg、血红蛋白浓度、Kt／V是MHD患者全因死亡的独立危险因素。结论透后血压显著升高的MHD患者有较高死亡危险度；ASBP〈-0．25mmHg、血红蛋白浓度、Kt／V是MHD患者全因死亡的独立危险因素。Objective To determine the relationship between changes of blood pressure （BP） during dialysis and mortality in maintenance hemodialysis （MHD） patients. Methods A total of 364 cases of MHD patients were collected prospectively and the relationship between changes of blood pressure during dialysis and mortality was assessed. Results The patients＂ age was （63.07±13.93） years. Over a follow-up of （54.86 ± 19.84） months, a total of 85 （23.4%） all- cause and 46（12.6%） cardiovascular deaths occurred. Post- dialytic drops in systolic BP between 7.08 mmHg and 14.25 mmHg were associated with lower all-cause and cardiovascular mortality [OR=0.324 and 0.335, 95%CI （0.152, 0.692） and （0.123, 0.911）, P=0.004 and 0.032, respectively]. Kaplan-Meier analysis showed that post- dialytic increase in systolic BP more than 0.25 mmHg was associated with higher all- cause and cardiovascular mortality （P=O.O01, 0.044, respectively）. Multivariate logistic regression analysis showed that post-dialytic increase in systolic BP more than 0.25 mmHg, hemoglobin, Kt/V were independent risk factors for all- cause mortality. Conclusions Post- dialytic increase in systolic BP more than 0.25 mmHg in MHD patients suggests higher mortality. Significant increased systolic BP after hemodialysis, hemoglobin level and Kt/V were independent risk factors for all-cause mortality.

关 键 词：血液透析 血压 高血压 死亡率 

分 类 号：R459.5[医药卫生—治疗学]