透析后血压变化的影响因素及与血管钙化的相关性研究  

Research on correlation between influencing factors of blood pressure changes and angiosteosis after hemodialysis

作　　者：张萍[1] 杨丽南[1] 阮一哲[1] 杨静[1] 徐海霞[1] 段志强[1] 董华萍[1] 马小平[1] 

机构地区：[1]解放军452医院肾病内科,成都610021

出　　处：《西南国防医药》2015年第7期719-722,共4页Medical Journal of National Defending Forces in Southwest China

摘　　要：目的研究维持性血液透析患者透析前后血压变化的影响因素及与血管钙化的相关性。方法纳入我院血液透析中心的MHD患者68例,采用腹部侧位片评估患者腹主动脉钙化情况。依据透析后血压变化情况将患者分为血压升高组(△SBP升高≥10 mm Hg)、血压降低组(△SBP降低≥10 mm Hg)和血压稳定组(△SBP变化<10 mm Hg),比较各组的血常规、透析前肝肾功能、电解质、血脂及血透指标等临床资料。结果透析过程中血压升高者24例(35.3%),血压降低者15例(22.1%),血压平稳者29例(42.6%),血压升高组和血压下降组的中位透析龄、透析间期体重增长量(IDWG)和体重增加率(IDWG%)、脱水量均高于血压平稳组(P<0.05)。血压升高组和血压降低组的血钙、血磷及钙磷乘积均明显高于血压平稳组,3组的年龄、性别、糖尿病患病率、血常规、肝功能、血脂及腹主动脉钙化发生率均无明显差异。结论透析可引起血透患者血压波动,血压波动与机体容量负荷和血管僵硬度相关。干预脂代谢和钙磷代谢,控制透析间期体重增长,是否能减少透析患者血压波动,改善患者预后,尚需进一步观察研究证实。Objective To investigate the correlation between the influencing factors of patients＂ blood pressure changes and angiosteosis before and after hemodialysis. Methods 68 patients receiving MHD in the hemodialysis center of our hospital were enrolled in the study. Their abdominal aorta calcification was evaluated by lateral lumbar spine X-ray film. According to the blood pressure changes after the hemodialysis, those patients were divided in to increasing blood pressure （BP） group （ASBP increase ≥ 10 mmHg） and decreasing BP group （ASBP decreased ≥ 10 mmHg）, and stable BP group （ASBP changed 〈10 mmHg）. Comparison was made in the clinical data, such as blood routine, hepatic and renal function, electrolyte, blood fat, and hemodialysis indexes before the hemodialysis among the groups. Results During the hemodialysis, 24 patients＇ blood pressure increased （35.3%）; 15 ones＇ blood pressure decreased （22.1%）; 29 ones＇ blood pressure was stable （42.6%）. The dialysis duration, interdialytic weight gain （IDWG）, weight increasing rate, dehydration volume in the increasing and decreasing BP groups were all higher than those in the stable BP group （P 〈 0.05）. The blood calcium, phosphorus, and calcium-phosphorus product of the former two groups were all significantly higher than those of the latter group. There was no significant difference in the age, sex, attack rate of diabetes, blood routine, hepatic function, blood fat, and incidence of abdominal aorta calcification among the three groups. Conclusion Hemodialysis can lead to fluctuation of blood pressure which is correlated with body volume toad and vessel stiffness. It needs further observation and verification that whether clinical intervention of lipid metabolism and calcium and phosphorus metabolism and the control of the interdialytic weight gain can reduce the fluctuation.

关 键 词：血液透析 血压 血管 钙化 影响因素 

分 类 号：R692.5[医药卫生—泌尿科学]