尿毒症治疗中血压改变对血透患者生存状况的影响  

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

作　　者：袁飞[1] 张亚杰[2] 

机构地区：[1]东莞市人民医院肾内科,广东东莞523059 [2]广州医科大学附属第二医院肾内科,广东广州510260

出　　处：《西部医学》2015年第8期1163-1165,1168,共4页Medical Journal of West China

基　　金：国家自然科学基金(81000291)

摘　　要：目的探讨尿毒症治疗过程中血压改变对血透患者生存状况的影响。方法选择2010年1月至2012年1月在我院就诊的尿毒症患者104例,收集所有患者的性别、年龄、干体重、身高、透析龄以及透析前后患者的血压生化指标等一般资料。患者均采用碳酸氢盐透析液。在血透前、血透过程中以及血透结束后对患者的血压进行测量并如实记录。两年内的每个季度第一次透析前和透析结束时,记录下患者的血压值,并根据血压值计算出患者的的舒张压和收缩压的标准差和平均值。评估血液透析过程中患者血压的变化与死亡率之间的关系。结果对104位患者进行随访（54.889±19.843）个月。死亡人数为19（18.27%）,血透前与血透后收缩压（▽SBP）在7.08～14.25mmHg之间的患者发生死亡的人数最低,差异具有统计学意义（P〈0.05）。Kaplan-Meier分析显示血透后血压升高大于0.25mmHg的患者的死亡率明显升高。多因素Logistic回归分析结果显示▽SBP〈-0.025mmHg、血红蛋白浓度大小以及Kt/V是尿毒症患者死亡的主要危险因素。结论尿毒症患者血透后血压显著升高,此时患者具有较高的死亡危险度;▽SBP〈-0.25mmHg、血红蛋白浓度大小以及Kt/V是尿毒症患者全因死亡的独立危险因素。Objective To explore the treatment effect of blood pressure changes in the process of hemodialysis pa- tients with uremia blood on the survival state. Methods 104 uremia patients were involved in the present study. The patienfs sex, age, dry weight, height, age of patients before and after dialysis and dialysis blood biochemical indicators of general information were analyzed. All patients were treated with bicarbonate dialysate. The patient＇s blood pressure before hemodialysis, during hemodialysis and after hemodialysis was measured. The relationship between the changes of blood pressure and mortality in patients was analyzed. Results Follow up was done in 104 patients （54. 889±19. 843） months. 19 cases （18.27%） were dead. The death rate of systolic blood pressure between 7.08~14.25mmHg before and after hemodialysis was the lowest of the patients （P〈0.05）. Kaplan-Meier analysis showed that the mortality of the patients of the dialysis blood pressure greater than 0.25mmHg significantly increased. Multiple Logistic regression analy- sis indicated that at SBP〈-0. 025mmHg, hemoglobin concentration and size of Kt/V were the main risk factors of death in patients with uremia. Conclusion Blood pressure in uremic patients after hemodialysis significantly increases. The patients have a high risk of death. SBP〈--0.25mmHg, hemoglobin concentration and Kt/V are the independent risk factors for death of uremic patients.

关 键 词：血压改变 尿毒症 血透 

分 类 号：R692.5[医药卫生—泌尿科学]