维持性血液透析患者透析相关性高血压的变化及其影响因素分析

摘要

To investigate the incidence of intradialytic hypertension and its influence factors in patients with maintenance hemodialysis. Methods 80 hemodialysis patients were enrolled in the study, and divided into three groups: Ⅰ group: 22 cases, age ＜ 45; Ⅱ group: 28 cases, 45 ≤age ＜ 65; Ⅲ group: 30 cases, age ＞ 65. Intradialytic hypertension events were recordel in 4899 dialysis visits of all the subjects from July lth, 2010 to December 31th, 2010. Patients' age, average heart rate of intradialysis, IDWG％, HGB, state of EPO treatment were recorded.The influence factors on intradialytic hypertension events were analyzed. Results In 4899 dialysis visits, there were 94 cases of hypertension, the incidence of intradialytic hypertension was 1.9％. 44 cases of intradialytic hypertension were after the end of dialysis (46.8％), followed by one-hour after the start of dialysis (31.9％), two-hour (13.8％),three-hour (7.5％). The incidence of intradialytic hypertension were significantly higher in Ⅰ group than that in Ⅱ group and Ⅲ group (P＜0.05). PreMAP were significantly lower in cases of intradialytic hypertension than that in none-cases of intradialytic hypertension (P＜0.01); average heart rate of intradialysis, iPTH, treatment with EPO, IDWG％ were higher in cases of intradialytic hypertension than those in none-cases of intradialytic hypcrtensinn (P＜0.05). The incidence of intradialytic hypertension was positively correlated with average heart rate of intra-dialysis, IDWG％, and treatment with EPO; while negatively with PreaMAP. Conclusion The incidence of intradialytic hypertension was 1.9％ in our hemodialysis center, intradialytic hypertension was influenced by many factors. Intradialytic hypertension were more prone to occurred in faster average heart rate of intra-dialysis, higher IDWG％ and lower Pre%目的 调查我院维持性血液透析患者透析相关性高血压的发生率,并分析其影响因素.方法 选择维持性血液透析患者80例,将入选的患者根据年龄分为3组:(1)Ⅰ组:年龄<45岁,22例;(2)Ⅱ组:45～65岁,28例;(3)Ⅲ组:年龄>65岁,30例.对全部研究对象2010年7月1日至12月31日共4 899例次的透析资料进行分析,探讨年龄、透析过程平均心率、透析前平均动脉压(PreMAP)、透析间期体重增长率(IDWG%)、血红蛋白(HGB)、血清甲状旁腺激素(iPTH)、重组人促红细胞生成素(EPO)使用情况与透析相关性高血压的关系.结果 ①全部4 899例次透析中,共出现94例次高血压,其发生率1.9%.44例次透析相关性高血压发生在透析结束后(46.8%),其次为透析开始后1 h(31.9%)、2 h(13.8%)、3 h(7.40%).②Ⅰ组患者的透析相关性高血压发生率显著高于Ⅱ组、Ⅲ组,差异有统计学意义(P<0.05).③发生透析相关性高血压的例次,其PreMAP显著低于未发生透析相关性高血压例次(P<0.01);其透析过程平均心率、iPTH、接受ESA治疗%)、IDWG%高于未发生透析相关性高血压例次(P<0.05).④Logistic回归分析:透析相关性高血压的发生与透析过程平均心率、IDWG%、接受ESA治疗(%)正相关,而和PreMAP负相关.结论 我院维持性血液透析患者透析相关性高血压的发生率为1.9%.透析相关性高血压受多种因素影响,透析过程心率越快、IDWG%越多、PreMAP越低,越容易出现透析相关性高血压.