伴有高血压的维持性血液透析患者透析期间血压节律变化特点及干预研究  

Study on characteristics of blood pressure variation during dialysis interval and dialysis day in MHD patients with hypertension and the analysis of effect of intervention in advance

作　　者：王靖[1] 王晋生[1] 李娜[1] 齐云霞[1] 闫蕊[1] WANG Jing;WANG Jin-sheng;LI Na;QI Yun-xia;YAN Rui(Department of Nephrology, the Third Hospitai of Qinhuangdao,Hebei Province, Qinhuangdao 066000, Chin)

机构地区：[1]河北省秦皇岛市第三医院肾内科,河北秦皇岛066000

出　　处：《河北医科大学学报》2018年第5期528-532,共5页Journal of Hebei Medical University

基　　金：秦皇岛市市级科技计划(201602A122)

摘　　要：目的观察伴有高血压的维持性血液透析(maintenance hemodialysis,MHD)患者透析期间血压水平变化特点与个体化预干预对高血压疗效的影响。方法随机将伴有高血压的MHD患者158例采用数字表法分为试验组80例和对照组78例。录入透析过程中及透析间期不同时间连续测得的患者血压数据,截取3d的血压记录,制作折线图,观察血压变化规律。试验组根据摸索出的规律给予预见性干预,对照组给予常规护理干预,比较2组血压异常发生率、生存质量、在观察期内的心脑血管不良事件发生率。结果试验组透析间期和透析日的24h平均收缩压、24h平均舒张压、日平均收缩压、日平均舒张压、夜平均收缩压、夜平均舒张压均低于对照组(P<0.05);2组透析间期和透析日的杓型节律、非杓型节律与反杓型节律发生率差异均无统计学意义(P>0.05)。试验组血压异常发生率低于对照组(P<0.05)。试验组SF-36总分及各维度评分均高于对照组(P<0.05);试验组总心脑血管事件发生率低于对照组(P<0.05)。结论用血压折线图规律性分析发现伴有高血压的透析患者存在血压变异,变异特点主要表现为非杓型与反杓型血压;给予个体化预干预可减少患者血压异常发生率,改善其生存质量,减少其心脑血管事件发生率。Objective To study the characteristics of dynamic blood pressure variation of dialysis interval and dialysis day in maintenance hemodialysis（MHD）patients with hypertension and the effect of nursing care intervention.Methods As the subjects of study,158 patients with MHD with hypertension were randomly divided into experimental group（80 cases）and control group（78 cases）by digital table.The blood pressure data was recorded continuously during dialysis interval and dialysis day in MHD patients,and the blood pressure was recorded for 3 days,and the broken line graph was made to observe the change of blood pressure.The experimental group was given pre-intervention according to the law of the exploration,the control group was given the routine nursing intervention.The incidence of abnormal blood pressure,quality of life and the incidence of cardiovascular events during the observation period were compared.Results The mean systolic pressure of 24 hours,mean diastolic pressure of 24 hours,daily mean systolic pressure,daily mean diastolic pressure,night mean systolic pressure and night mean diastolic pressure of the experimental group in dialysis interval and dialysis day were lower than those of the control group（P〈0.05）.There was no significant difference between the dipper type rhythm and the non-dipper type rhythm（P〉0.05）.The incidence of abnormal blood pressure in the experimental group was lower than that in the control group（P〈0.05）.The total score of SF-36 and all dimensions in the experimental group were higher than that in the control group,the differences are statistically significant between the two groups（P〈0.05）.The incidence of cardiovascular events in the experimental group was lower than in the control groups（P〈0.05）.Conclusion There are abnormalities of hypertension and rhythm in patients with MHD by the regular analysis of blood pressure broken line graph.The variation characteristics of blood pressure is mainly non-dipper and anti-dipper.The individualized nurs

关 键 词：肾透析 高血压 护理 

分 类 号：R459.5[医药卫生—治疗学]