血压变异性对老年血液透析患者认知功能的影响  

Effect of blood pressure variability on cognitive function of elderly patients during hemodialysis

作　　者：余灵安[1] 吴鑫洪 韩颖敏 YU Ling′an;WU Xinhong;HAN Yingmin(Department of Nephrology,Taizhou First People′s Hospital in Zhejiang Province,Taizhou318020,China)

机构地区：[1]浙江省台州市第一人民医院肾内科,浙江台州318020

出　　处：《中国现代医生》2022年第4期52-55,共4页China Modern Doctor

基　　金：浙江省医药卫生科技计划项目(2020PY089);浙江省台州市黄岩区科技计划项目(2015050-4)。

摘　　要：目的探讨血液透析间期血压的变异性与老年尿毒症患者认知功能损害的关系。方法选取2017年1月至2019年9月在浙江省台州市第一人民医院接受维持性血液透析(MHD)老年尿毒症患者80例作为研究对象,监测患者透析间期24 h动态血压,根据夜间收缩压下降百分率分为非杓型组(n=44)和反杓型组(n=36),比较两组的平均血压、血压变异性和夜间血压下降率。采用简易智能精神状态检查量表(MMSE)对两组患者进行认知功能检测,比较两组间MMSE得分差异。结果反杓型组患糖尿病比率高于非杓型组(P<0.05);与非杓型组比较,反杓型组nSBP、24 hSBPV、nSBPV、24 hDBPV、dDBPV和nDBPV较高(P<0.05),而ΔSBP%和ΔDBP%较低(P<0.001);反杓型组MMSE总得分、定向力和记忆力MMSE得分均低于非杓型组,差异有统计学意义(P<0.05)。结论老年血液透析患者存在血压变异性异常,血压节律主要表现为“非杓型”与“反杓型”血压,其中“反杓型”血压患者更容易发生认知功能损害,主要表现在定向力和记忆力方面。Objective To investigate the relationship between blood pressure variability(BPV)during hemodialysis and cognitive impairment in elderly uremic patients.Methods A total of 80 elderly uremic patients who received maintenance hemodialysis(MHD)in Taizhou First People's Hospital in Zhejiang Province from January 2017 to September 2019 were selected as research objects.The 24-hour ambulatory blood pressure of patients was monitored during the hemodialysis.According to the drop percentage of nocturnal systolic blood pressure(nSBP),the patients were divided into the non-dipper group(n=44)and the anti-dipper group(n=36).The mean blood pressure,BPV and the drop percentage in nSBP of the two groups were compared.The Mini Mental State Examination(MMSE)was used to examine the cognitive function of the two groups of patients,and the differences in MMSE scores between the two groups were compared.Results The incidence of diabetes was higher in the anti-dipper group than that in the non-dipper group(P<0.05).Compared with the non-dipper group,nSBP,24 hSBPV,nSBPV,24 hDBPV,dDBPV and nDBPV were higher in the anti-dipper group(P<0.05),whileΔSBP%andΔDBP%were lower in the anti-dipper group(P<0.001).The total score of MMSE,the scores of orientation and memory in MMSE were lower in the anti-dipper group than those in the non-dipper group,with statistically significant difference(P<0.05).Conclusion There are abnormal BPV in elderly patients during hemodialysis.The blood pressure(BP)rhythm is mainly manifested as"non-dipper"and"anti-dipper"BP.Among them,the patients with"anti-dipper"BP are prone to cognitive impairment,mainly manifested in orientation and memory.

关 键 词：血压变异性 血液透析 动态血压 认知功能 

分 类 号：R459.5[医药卫生—治疗学] R692[医药卫生—临床医学]