CAJ | 학술논문

目的评估维持性血液透析(MHD)患者透析过程中血压变异性(BPV)情况,探讨影响MHD过程中BPV增加的相关危险因素,了解其与预后的关系.方法对2009年1月1日以前开始在上海交通大学附属第一人民医院常规透析的MHD患者行回顾性分析.记录2009年1月-2010年12月期间每季度第1次血液透析过程中所有血压值,求取收缩压、舒张压的平均值和标准差,以离散系数表示透析中收缩压和舒张压BPV.随访时间未满2年的患者取时间平均分布的6～8个透析过程的血压计算.记录心血管事件及死亡,继续随访至2011年12月31日.结果共纳入280例患者.平均透析中收缩压BPV为0.119 ±0.029,舒张压BPV为0.118 ±0.028;其中老年MHD患者(114例)透析中收缩压的BPV显著高于青中年组(166例)(0.126±0.029比0.114 ±0.028,P=0.012),两组间透析中舒张压的BPV差异无统计学意义(0.117±0.031比0.119 ±0.025,P=0.498).将透析中收缩压BPV作为应变量进行多元回归分析,结果显示患者年龄、透析前收缩压、透析间期体重增长率及血红蛋白水平是透析中收缩压BPV的独立影响因素.将透析中舒张压BPV作为应变量进行多元回归分析,结果显示透析间期体重增长率、平均脱水量是透析中舒张压BPV的独立影响因素.随访3年,死亡64例(22.9％),生存分析显示透析中收缩压BPV升高与病死率升高显著相关(P＜0.01).结论高龄、透析前高收缩压、透析间期体重增长率增加、血红蛋白水平降低为MHD患者透析中收缩压BPV升高的独立危险因素,透析间期体重增长率增加为MHD患者舒张压BPV升高的独立危险因素,透析中收缩压的BPV升高与MHD患者全因死亡率增加有关.
목적 평고유지성혈액투석(MHD)환자투석과정중혈압변이성(BPV)정황,탐토영향MHD과정중BPV증가적상관위험인소,료해기여예후적관계.방법 대2009년1월1일이전개시재상해교통대학부속제일인민의원상규투석적MHD환자행회고성분석.기록2009년1월-2010년12월기간매계도제1차혈액투석과정중소유혈압치,구취수축압、서장압적평균치화표준차,이리산계수표시투석중수축압화서장압BPV.수방시간미만2년적환자취시간평균분포적6～8개투석과정적혈압계산.기록심혈관사건급사망,계속수방지2011년12월31일.결과 공납입280례환자.평균투석중수축압BPV위0.119 ±0.029,서장압BPV위0.118 ±0.028;기중노년MHD환자(114례)투석중수축압적BPV현저고우청중년조(166례)(0.126±0.029비0.114 ±0.028,P=0.012),량조간투석중서장압적BPV차이무통계학의의(0.117±0.031비0.119 ±0.025,P=0.498).장투석중수축압BPV작위응변량진행다원회귀분석,결과현시환자년령、투석전수축압、투석간기체중증장솔급혈홍단백수평시투석중수축압BPV적독립영향인소.장투석중서장압BPV작위응변량진행다원회귀분석,결과현시투석간기체중증장솔、평균탈수량시투석중서장압BPV적독립영향인소.수방3년,사망64례(22.9％),생존분석현시투석중수축압BPV승고여병사솔승고현저상관(P＜0.01).결론 고령、투석전고수축압、투석간기체중증장솔증가、혈홍단백수평강저위MHD환자투석중수축압BPV승고적독립위험인소,투석간기체중증장솔증가위MHD환자서장압BPV승고적독립위험인소,투석중수축압적BPV승고여MHD환자전인사망솔증가유관.
Objective To evaluate intradialytic blood pressure variability (BPV) in patients on maintenance hemodialysis (MHD),and to investigate the correlated factors of BPV in MHD process and its correlation with prognosis.Methods Patients with end stage renal disease on MHD before January 1,2009 were enrolled and analyzed retrospectively.Blood pressure at the first hemodialysis every quarter during January,2009 and December,2010 were recorded.The systolic pressure,diastolic pressure were calculated,and dialysis systolic and diastolic BPV were expressed with discrete coefficients.As for patients with follow-up time less than 2 years,blood pressures in evenly distributed 6-8 courses were used for calculation.Cardiovascular events and death were recorded and the follow-up was lasted till December 31,2011.Results A total of 280 patients were enrolled,with intradialytic systolic BPV of 0.119 ± 0.029,and intradialytic diastolic BPV of 0.118 ±0.028.Intradialytic systolic BPV in the elderly group (n =114) was significantly higher than that in the younger group (n =166) (0.126 ± 0.029 vs 0.114 ± 0.028,P =0.012),while no significant difference was found in diastolic BPV (0.117 ±0.031 vs 0.119 ±0.025,P =0.498).Intradialytic systolic BPV was used as variates in multivariable regression analysis,and results showed that age,systolic blood pressure before dialysis,interdialytic weight gain (IDWG) rate during dialysis and hemoglobin level were independent influential factors for intradialytic systolic BPV.The intradialytic diastolic BPV was used as variates in multivariable regression analysis,and results showed that IDWG rate and average dehydration volume were independent influential factors for intradialytic diastolic BPV.During 3 years of follow-up,64 patients died (22.9％).The survival analysis showed that the dialysis systolic BPV elevation was associated with the mortality rate (P ＜ 0.01).Conclusions Older age,high systolic pressure before hemodialysis,high IDWG rate,and low hemoglobin level were independent risk factors of high intradialytic systolic BPV increase.Intradialytic high IDWG is an independent risk factor of high intradialytic diastolic BPV increase in patients on MHD.Intradialytic systolic BPV increase is associated with all-cause mortality in patients on MHD.