维持性血液透析患者透析中低血压及相关危险因素的临床研究  

The Clinical Study of Intradialytic Hypotension and Related Risk Factors in Dialysis in Patients on Maintenance Hemodialysis

作　　者：阳小敏 侯新艳 李鸿志[1] 张苗苗 姚茂容 杨冰洁 YANG Xiaomin;HOU Xinyan;LI Hongzhi;ZHANG Miaomiao;YAO Maorong;YANG Bingjie(Department of Nephrology,the First People’s Hospital of Xiangtan City,Xiangtan Hu’nan 411100,China)

机构地区：[1]湘潭市第一人民医院肾内科,湖南湘潭411100

出　　处：《中国卫生标准管理》2023年第11期107-111,共5页China Health Standard Management

基　　金：湖南省湘潭市医学科研项目(2022-xtyx-48)。

摘　　要：目的通过对发生透析中低血压(intradialytic hypotension,IDH)的相关危险因素的研究,为IDH的防治提供帮助。方法收集湘潭市第一人民医院血液净化中心2022年8月—2023年2月186例血液透析患者的临床资料,根据连续性3个月低血压发生的频率,分成非IDH组105例及IDH组81例。IDH定义是指与临床事件相关的收缩压下降>20 mmHg,或者平均动脉压下降≥10 mmHg,同时合并有低血压症状。比较两组之间的各项数据,多因素分析采用Logistic回归分析其与IDH之间的关系。结果入组的186例血液透析患者中,发生IDH的患者81例(43.55%),没有发生低血压的患者105例(56.45%)。主要并发症为高血压、糖尿病、慢性肾小球肾炎、缺血性心肌病、周围血管病、脑血管病,两组间比较,差异无统计学意义(P>0.05)。两组身体质量指数(body mass index,BMI)、血尿素氮、血肌酐、血钾、校正钙、无机磷、低密度脂蛋白胆固醇(low-density lipoprotein-cholesterol,LDH-C)、全型甲状旁腺激素(intact parathyroid hormone,iPTH)、铁蛋白比较,差异无统计学意义(P>0.05)。与非IDH组比较,IDH组的超滤率、透析间期体质量增长率(interdialysis weight gain rate,IDWGR)升高(P<0.05);与非IDH组比较,IDH组的血红蛋白、总蛋白、白蛋白降低(P<0.05)。Logistic回归分析显示,透析间期体质量增长率及血浆白蛋白与IDH的发生密切相关(P<0.05)。结论过高的透析间期体质量增长率、较低的白蛋白水平是维持性血液透析(maintenance hemodialysis,MDH)患者发生IDH的独立危险因素。Objective It provides assistance in the prevention and treatment of IDH by analyzing the risk factors associated with the occurrence of intradialytic hypotension(IDH)in dialysis.Methods It collected clinical data from 186 hemodialysis patients in the hemodialysis unit of the First People’s Hospital of Xiangtan City from August 2022 to February 2023,and divided into 105 cases in the non-IDH group and 81 cases in the IDH group according to the frequency of hypotension occurring in 3 months of continuity.The definition of IDH is the decrease in systolic blood pressure>20 mmHg or the decrease in mean arterial pressure≥10 mmHg associated with a clinical event,combined with symptoms of hypotension.All data were compared between the two groups,and the relationship between them and IDH was analyzed by logistic regression for multifactorial analysis.Results There were 81 cases(43.55%)of IDH and 105 cases(56.45%)of no hypotension among the 186 hemodialysis patients enrolled.There was no significant difference between the two groups in the major comorbidities of hypertension,diabetes mellitus,chronic glomerulonephritis,ischemic cardiomyopathy,peripheral vascular disease,and cerebrovascular disease(P>0.05).The differences in body mass index(BMI),blood urea,blood creatinine,blood potassium,corrected calcium,inorganic phosphorus,low-density lipoprotein-cholesterol(LDL-C),intact parathyroid hormone(iPTH),and ferritin were not significant between the two groups compared(P>0.05).In comparison with the non-IDH group,the rate of ultrafiltration and interdialysis weight gain rate(IDWGR)between dialysis were higher in the IDH group(P<0.05).The IDH group had lower hemoglobin,total protein,and albumin compared with the non-IDH group(P<0.05).The Logistic regression analysis showed that interdialysis weight gain rate and plasma albumin were strongly associated with the occurrence of IDH(P<0.05).Conclusion Too high interdialysis weight gain rate,low albumin level are independent risk factors for IDH in maintenance hemodialysis(MDH)pat

关 键 词：血液透析 透析间期体质量增长率 透析中低血压 终末期肾病 白蛋白 超滤率 

分 类 号：R459[医药卫生—治疗学]