CAJ | 학술논문

目的探讨维持性血液透析(MHD)患者透析中血压变化和全因死亡、心血管病死亡之间的关系.方法收集2007年7月至2012年12月上海交通大学医学院附属仁济医院MHD患者一般情况、生化指标以及生存预后.评估血液透析过程中患者血压变化与死亡之间关系.结果364例患者年龄为(63.07±13.93)岁,中位透析龄为76.00(42.25,134.00)个月,随访时间为(54.86±19.84)个月,全因死亡患者85例,占入选人数的23.4％,心血管病死亡46例,占入选人数的12.6％.透前与透后收缩压差(△SBP)在7.08 mmHg至14.25 mmHg之间的患者发生全因死亡以及心血管死亡的危险度最低[OR分别为0.324和0.335,95％CI分别为(0.152,0.692)和(0.123,0.911),P值分别为0.004和0.032].Kaplan-Meier分析显示透后血压升高大于0.25 mmHg(△SBP＜-0.25 mmHg)的患者其全因死亡、心血管病死亡均显著增加(P值分别为0.001和0.044).多因素Logistic回归分析显示△SBP＜-0.25 mmHg、血红蛋白浓度、Kt/V是MHD患者全因死亡的独立危险因素.结论透后血压显著升高的MHD患者有较高死亡危险度;△SBP＜-0.25 mmHg、血红蛋白浓度、Kt/V是MHD患者全因死亡的独立危险因素.
목적 탐토유지성혈액투석(MHD)환자투석중혈압변화화전인사망、심혈관병사망지간적관계.방법 수집2007년7월지2012년12월상해교통대학의학원부속인제의원MHD환자일반정황、생화지표이급생존예후.평고혈액투석과정중환자혈압변화여사망지간관계.결과364례환자년령위(63.07±13.93)세,중위투석령위76.00(42.25,134.00)개월,수방시간위(54.86±19.84)개월,전인사망환자85례,점입선인수적23.4％,심혈관병사망46례,점입선인수적12.6％.투전여투후수축압차(△SBP)재7.08 mmHg지14.25 mmHg지간적환자발생전인사망이급심혈관사망적위험도최저[OR분별위0.324화0.335,95％CI분별위(0.152,0.692)화(0.123,0.911),P치분별위0.004화0.032].Kaplan-Meier분석현시투후혈압승고대우0.25 mmHg(△SBP＜-0.25 mmHg)적환자기전인사망、심혈관병사망균현저증가(P치분별위0.001화0.044).다인소Logistic회귀분석현시△SBP＜-0.25 mmHg、혈홍단백농도、Kt/V시MHD환자전인사망적독립위험인소.결론 투후혈압현저승고적MHD환자유교고사망위험도;△SBP＜-0.25 mmHg、혈홍단백농도、Kt/V시MHD환자전인사망적독립위험인소.
Objective To determine the relationship between changes of blood pressure (BP) during dialysis and mortality in maintenance hemodialysis (MHD) patients.Methods A total of 364 cases of MHD patients were collected prospectively and the relationship between changes of blood pressure during dialysis and mortality was assessed.Results The patients' age was (63.07± 13.93) years.Over a follow-up of (54.86± 19.84) months,a total of 85 (23.4％) all-cause and 46(12.6％)cardiovascular deaths occurred.Post-dialytic drops in systolic BP between 7.08 mmHg and 14.25 mmHg were associated with lower all-cause and cardiovascular mortality [OR=0.324 and 0.335,95％CI (0.152,0.692) and (0.123,0.911),P=0.004 and 0.032,respectively].Kaplan-Meier analysis showed that post-dialytic increase in systolic BP more than 0.25 mmHg was associated with higher all-cause and cardiovascular mortality (P=0.001,0.044,respectively).Multivariate logistic regression analysis showed that post-dialytic increase in systolic BP more than 0.25 mmHg,hemoglobin,Kt/V were independent risk factors for all-cause mortality.Conclusions Post-dialytic increase in systolic BP more than 0.25 mmHg in MHD patients suggests higher mortality.Significant increased systolic BP after hemodialysis,hemoglobin level and Kt/V were independent risk factors for all-cause mortality.