中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2013年
7期
2900-2903
,共4页
尚云霄%王明晓%蒋秀梅%董卫红
尚雲霄%王明曉%蔣秀梅%董衛紅
상운소%왕명효%장수매%동위홍
肾透析%体重%体重增长%血压
腎透析%體重%體重增長%血壓
신투석%체중%체중증장%혈압
Renal dialysis%Body weight%Weight gain%Blood pressure
目的了解维持性血液透析（ MHD）患者透析间期体重增长率（ PIWG）与透析前及透析后血压波动的关系。方法共纳入规律血液透析6个月以上，每周3次透析，18岁及以上成年患者72例，男39例（54.17％），女33例，平均年龄（64.38±13.28）（29～82）岁，平均透析龄（4.12±4.28）（0.5～20）年。测定MHD患者透析前体重，计算超滤量（UF）（透析前体重-前次透析后体重）及PIWG[（透析前体重-前次透析后体重）/干体重×100％]。测定患者透析前血压、透析中每小时血压及透析后血压，并计算收缩压（SBP）差值（dSBP）（透析前SBP-透析后SBP）。收集4周内，共计942例次血液透析治疗，筛选795组完整有效数据。结果入选患者平均干体重为（62.83±11.84）kg，平均超滤量为（3.01±0.85）L，平均PIWG为4.85％±1.24％。透析前SBP （151.20±23.63） mm Hg，透析后SBP（146.27±26.58） mm Hg，差异有统计学意义（ P＜0.001）。相关分析显示，PIWG与透析前SBP （ P＝0.038）及dSBP （ P＜0.001）呈正相关，而与透析后SBP呈负相关（P＜0.001）。透析间期体重每增长1％，则透析前SBP增加1.72 mm Hg（P＝0.038，95％CI 0.093～3.347），透析后 SBP 下降4.278 mm Hg （ P ＜0.001，95％ CI -6.076～-2.477）， dSBP 增加5.998 mm Hg （ P＜0.001，95％CI 4.166～7.830）。结论 PIWG与透析前SBP及dSBP呈正相关，与透析后SBP呈负相关。容量负荷的变化对SBP的影响比舒张压大。
目的瞭解維持性血液透析（ MHD）患者透析間期體重增長率（ PIWG）與透析前及透析後血壓波動的關繫。方法共納入規律血液透析6箇月以上，每週3次透析，18歲及以上成年患者72例，男39例（54.17％），女33例，平均年齡（64.38±13.28）（29～82）歲，平均透析齡（4.12±4.28）（0.5～20）年。測定MHD患者透析前體重，計算超濾量（UF）（透析前體重-前次透析後體重）及PIWG[（透析前體重-前次透析後體重）/榦體重×100％]。測定患者透析前血壓、透析中每小時血壓及透析後血壓，併計算收縮壓（SBP）差值（dSBP）（透析前SBP-透析後SBP）。收集4週內，共計942例次血液透析治療，篩選795組完整有效數據。結果入選患者平均榦體重為（62.83±11.84）kg，平均超濾量為（3.01±0.85）L，平均PIWG為4.85％±1.24％。透析前SBP （151.20±23.63） mm Hg，透析後SBP（146.27±26.58） mm Hg，差異有統計學意義（ P＜0.001）。相關分析顯示，PIWG與透析前SBP （ P＝0.038）及dSBP （ P＜0.001）呈正相關，而與透析後SBP呈負相關（P＜0.001）。透析間期體重每增長1％，則透析前SBP增加1.72 mm Hg（P＝0.038，95％CI 0.093～3.347），透析後 SBP 下降4.278 mm Hg （ P ＜0.001，95％ CI -6.076～-2.477）， dSBP 增加5.998 mm Hg （ P＜0.001，95％CI 4.166～7.830）。結論 PIWG與透析前SBP及dSBP呈正相關，與透析後SBP呈負相關。容量負荷的變化對SBP的影響比舒張壓大。
목적료해유지성혈액투석（ MHD）환자투석간기체중증장솔（ PIWG）여투석전급투석후혈압파동적관계。방법공납입규률혈액투석6개월이상，매주3차투석，18세급이상성년환자72례，남39례（54.17％），녀33례，평균년령（64.38±13.28）（29～82）세，평균투석령（4.12±4.28）（0.5～20）년。측정MHD환자투석전체중，계산초려량（UF）（투석전체중-전차투석후체중）급PIWG[（투석전체중-전차투석후체중）/간체중×100％]。측정환자투석전혈압、투석중매소시혈압급투석후혈압，병계산수축압（SBP）차치（dSBP）（투석전SBP-투석후SBP）。수집4주내，공계942례차혈액투석치료，사선795조완정유효수거。결과입선환자평균간체중위（62.83±11.84）kg，평균초려량위（3.01±0.85）L，평균PIWG위4.85％±1.24％。투석전SBP （151.20±23.63） mm Hg，투석후SBP（146.27±26.58） mm Hg，차이유통계학의의（ P＜0.001）。상관분석현시，PIWG여투석전SBP （ P＝0.038）급dSBP （ P＜0.001）정정상관，이여투석후SBP정부상관（P＜0.001）。투석간기체중매증장1％，칙투석전SBP증가1.72 mm Hg（P＝0.038，95％CI 0.093～3.347），투석후 SBP 하강4.278 mm Hg （ P ＜0.001，95％ CI -6.076～-2.477）， dSBP 증가5.998 mm Hg （ P＜0.001，95％CI 4.166～7.830）。결론 PIWG여투석전SBP급dSBP정정상관，여투석후SBP정부상관。용량부하적변화대SBP적영향비서장압대。
Objective To investigate the relationship between the percentage of interdialysis weight gain (PIWG ) and the variability of blood pressure ( BP ) among maintenance hemodialysis ( MHD ) patients. Methods There were 72 adult patients ( 39 men and 33 women ) , ages more than 18 , treatment with hemodialysis thrice a week at least 6 months recruited in this study.Average ages were (64.38 ±13.28)(29-82)years,average duration of hemodialysis were (4.12 ±4.28)(0.5-20)years.Ultrafiltration quantity(UF) =predialysis weight -previous postdialysis weight .PIWG =( predialysis weight -previous postdialysis weight )/dry weight ×100%.The blood pressure of predialysis ,every hour in intradialysis ,postdialysis were recorded .The difference of systolic blood pressure(dSBP)=predialysis SBP-postdialysis SBP.There were total of 942 treatment sessions in 4 weeks,and 795 treatment sessions that had complete records were enrolled in this study .Results The MHD patients′average dry weights was (62.83 ±11.84)kg,average UF was (3.01 ±0.85)L,average PIWG was(4.85 ±1.24)%.Predialysis SBP were (151.20 ±23.63)mm Hg,and postdialysis SBP were (146.27 ±26.58)mm Hg,difference was obvious in the two items(P<0.001).Bivariate correlation suggested that PIWG had a positive relation with predialysis SBP (P=0.038 ) and dSBP ( P<0.001 ) .And had a negative relation with postdialysis SBP ( P<0.001 ) .Linear regression showed that 1%increase in PIW was associated with 1.72 mm Hg ( P=0.038 ,95% CI 0.093-3.347 ) increase in predialysis SBP ,4.278 mm Hg( P<0.001 ,95%CI -6.076--2.477 ) decrease in postdialysis SBP ,5.998 mm Hg ( P<0.001 ,95%CI 4.166-7.830 ) increase in dSBP .Conclusions PIWG had a positive relation with predialysis SBP and dSBP , and a negative relation with postdialysis SBP .The change of volume load in MHD patients had a bigger effect on SBP than diastolic blood pressure ( DBP) .
