透析前血浆渗透压对老年维持性血液透析患者频繁透析中低血压的预测意义  

Predictive significance of predialysis plasma osmolality for frequent intradialytic hypotension in elders on maintenance hemodialysis

作　　者：姜小红 翁丽娜 Jiang Xiao-hong;Weng Li-na(Blood Purification Unit,Municipal People’s Hospital,Hai'an 226600,China)

机构地区：[1]海安市人民医院血液净化室,海安226600

出　　处：《临床肾脏病杂志》2024年第2期116-120,共5页Journal Of Clinical Nephrology

摘　　要：目的探讨透析前血浆渗透压对老年维持性血液透析患者频繁透析中低血压(intradialytic hypotension,IDH)的预测意义。方法选取301例老年维持性血液透析患者为研究对象,根据是否发生频繁IDH分为对照组(257例)和频繁IDH组(44例)。收集患者的一般临床、实验室检查和心脏B型超声检查结果。通过多因素logistic回归明确频繁IDH发生的危险因素。利用受试者工作特征曲线探讨透析前血浆渗透压对频繁IDH的预测作用。结果同对照组相比,频繁IDH组患者超滤率[(10.50±2.00)mL·(kg·h)^(-1)比(9.28±2.02)mL·(kg·h)^(-1)]、甲状旁腺激素和透析前血浆渗透压更高,而血红蛋白[(106.91±6.74)g/L比(113.04±10.30)g/L]、血清白蛋白[(106.91±6.74)g/L比(113.04±10.30)g/L]、左心室射血分数[(46.93±3.77)%比(51.63±4.73)%]和尿素清除指数[(1.33±0.33)比(1.50±0.20)]更低(均P<0.05)。多因素分析结果表明,高超滤率(OR=1.24)、高甲状旁腺激素(OR=1.01)以及高透析前血浆渗透压(OR=1.22)是发生频繁IDH的危险因素,而高血清白蛋白(OR=0.82)、高左心室射血分数(OR=0.73)是其保护性因素。当最佳切割值取301.6 mOsm·(kg·H_(2)O)^(-1)时,透析前血浆渗透压预测频繁IDH的曲线下面积为0.79,敏感性和特异性分别为58.5%和91.1%。结论透析前高血浆渗透压患者更容易发生频繁IDH,应对此类患者加以关注。Objective To explore the predictive value of predialysis plasma osmolality for frequent intradialytic hypotension(IDH)in elders on maintenance hemodialysis(MHD).Methods According to whether or not there was frequent IDH,301 MHD elders were assigned into two groups of control(n=257)and frequent IDH(n=44).General profiles,laboratory parameters and cardiac B-ultrasound examinations were recorded.The risk factors for frequent IDH were identified by multivariate Logistic regression.Receiver operating characteristic(ROC)curve was plotted for exploring the predictive efficacy of predialysis plasma osmolality for frequent IDH.Results As compared with control group,ultrafiltration rate,parathyroid hormone(PTH)and predialysis plasma osmolality spiked obviously while hemoglobin,serum albumin(Alb),left ventricular ejection fraction(LVEF)and Kt/V declined markedly in frequent IDH group(all P<0.05).Multivariate analysis indicated that elevations of ultrafiltration rate(OR=1.24),PTH(OR=1.01)and predialysis plasma osmolality(OR=1.22)were risk factors for frequent IDH while elevations of Alb(OR=0.82)and LVEF(OR=0.73)were its protective factors.With an optimal cut-off value of 301.6 mOsm/(kg.H2O),area under the curve for predicting frequent IDH by predialysis plasma osmolality was 0.79 with a sensitivity of 58.5% and a specificity of 91.1%.Conclusion Elders with an elevation of predialysis plasma osmolality are more susceptible to frequent IDH.They deserve a heightened attention.

关 键 词：血浆渗透压 肾透析 老年 

分 类 号：R692.5[医药卫生—泌尿科学]