低血压对血液透析患者远期生存状况的影响  

Effect of hypotension on long-term survival status in hemodialysis patients

作　　者：郭立华[1] 倪梓元[1] 辛光大[1] 

机构地区：[1]吉林大学中日联谊医院肾内科,长春130031

出　　处：《检验医学与临床》2017年第22期3344-3346,共3页Laboratory Medicine and Clinic

摘　　要：目的研究低血压(IDH)对血液透析患者远期生存状况的影响。方法选取2010年1月至2011年1月与该院血液净化中心进行维持性血液透析治疗的终末期肾病患者136例。发生IDH频率大于或等于10%者作为低血压组(58例),小于10%者作为非低血压组(78例)。患者入组时,采集患者一般资料和生化检测指标。门诊随访5年,记录2组预后转归情况。结果与非低血压组比较,低血压组患者年龄更大,女性比例更高,有残余尿患者比例、血清清蛋白(Alb)水平更低,氨基末端脑钠肽前体(NT-proBNP)水平更高,差异均有统计学意义(P<0.05)。随访5年期间,136例患者全部获得有效随访。其中死亡34例,病死率为25.00%。Logistic回归分析显示,年龄、有残余尿、Alb和NT-proBNP是血液透析患者发生IDH的独立影响因素。多变量COX回归分析表明,患者年龄、IDH、合并心血管疾病和脑血管病是患者远期预后(死亡)的独立预测因素。非低血压组累积生存率明显高于低血压组患者,差异有统计学意义(χ2=5.168,P=0.016)。结论 IDH是血液透析患者远期预后不良的危险因素。ObjectiveTo investigate the effect of intradialytic hypotension（IDH）on long term survival status in the patients with hemodialysis.MethodsA total of 136 patients with end stage renal disease undergoing maintenance hemodialysis in this hospital＇s blood purification center from January 2010 to January 2011 were selected.The patients with IDH frequency≥10% served as the hypotension group（58 cases）,and those with IDH frequency〈10% as the non hypotension group（78 cases）.The general data and biochemical testing indicators were collected.Clinic followed up lasted for 5 years.The prognosis and outcomes were recorded in the two groups.ResultsCompared with the non hypotension group,the age in hypotension group was older,female proportion was greater,proportions of residual urine and Alb level were lower and NT proBNP level was higher,the differences were statistically significant（P〈0.05）.During 5 year follow up period,136 cases completely obtained the effective followed up,among them 34 cases died,the mortality rate was 25.00%.The Logistic regression analysis showed that age,residual urine,Alb and NT proBNP were independent influencing factors of IDH occurrence in hemodialysis patients.Multivariate COX regression analysis showed that the patient age,IDH,complicating cardiovascular disease and cerebrovascular disease were independent predictive factors of long term prognosis（death）.The cumulative survival rate in the non hypotension group was significantly higher than that in the hypotension group,the difference was statistically significant（χ^2=5.168,P=0.016）.ConclusionIDH is a risk factor for long term poor prognosis in hemodialysis patients.

关 键 词：血液透析 透析中低血压 远期 预后 

分 类 号：R459.5[医药卫生—治疗学]