目的：探讨维持性血液透析（NHD）患者脉压（PP）及脉压指数（PPI）与心脏结构和功能的关系。方法：选取收治的NHD 高血压患者86例进行分析，老年患者32例，非老年患者54例，计算尿素下降率（URR），分析透析充分性，对所有患者进行心脏彩超检查，患者随访2年，观察老年组不同透析龄 PP 和 PPI 的变化，对透析充分组与不充分组 PP 和 PPI 进行比较，记录不同 PP 和PPI 患者心脏彩超指标变化及其与心血管事件（CVD）的关系。结果：在 NHD 开始和开始2年后，老年组患者 SBP、PP、PPI 明显高于非老年组（p ﹤0.05），两组在 DBP 和 NAP 上比较，差异无统计学意义（p ﹥0.05）；非老年组 NHD 开始2年后在 SBP、PP 和 PPI 上明显高于 NHD 开始前（p ﹤0.05），但在 DBP 和 NAP 上比较，差异无统计学意义（p ﹥0.05）；透析充分组与不充分组 SBP、NAP、PP、PPI在透析前存在显著差异（p ﹤0.05），在 DBP 上不存在显著差异（p ﹥0.05），两组透析后 SBP、DBP、NAP、PP、PPI 上比较，差异均具有统计学意义（p ﹤0.05）；不同 PP 和 PPI 患者各心脏彩超指标间比较，差异有统计学意义（p ﹤0.05），CVD 发生率存在显著差异（p ﹤0.05），提示随着 PP 和 PPI 的增加，左室收缩末期容积（LVDs）、左室舒张末期容积（LVDd）、射血分数（EF）、短轴缩短率（FS）等心脏彩超指标会发生明显变化，CVD 发生率会增加；经过 Ligistic 多因素回归分析，年龄、透析龄、URR、PP、PPI、LVDs、LVDd、EF、FS 均与心血管事件发生率相关，PP、PPI 尤为突出，除 URR、EF、FS 呈负相关，年龄、透析龄、LVDs、LVDd、PP、PPI 均呈正相关，提示 PP、PPI是 NHD 患者 CVD 的独立危险因素。结论：NHD 患者在透析期间 PP 和 PPI 会发生明显变化，透析的充分性对 PP 和 PPI 会产生重要影响；随着 PP 和 PPI 的增加，患者心脏彩超变化明显，心血管事件发生率明显增加；通过 PP 和 PPI 的监测能够有效预测心血管事件的危险性，说明维持性血液透析患者 PP 及 PPI 与心脏结构和功能有着密切关系。%Objective Ti investigate the relatiinship if the maintenance hemidialysis(NHD)patients between their pulse pressure (PP)and pulse pressure index(PPI)and their cardiac structure and functiin. Method 86 cases if NHD patients with hypertensiin were analyzed,including 32 cases if elderly patients,and 54 cases if nin elderly patients. Calculate their urea reductiin ratii(URR),analysis if the adequacy if dialysis,perfirm heart cilir ultrasiund examinatiin in all patients. The patients were filliwed up fir 2 years. Observe the change if different dialysis ages if the aged griup abiut PP and PPI. Ti cimpare the PP and PPI between the fully dialysis griup and nin fully dialysis griup,and recird the changes if cardiac ultrasiund index if patients having different PP and PPI,and find the relatiinship if cardiac ultrasiund index and cardiivascular events(CVD). Results At the NHD beginning and 2 years later,SBP,PP,PPI in elderly patients was significantly higher than that in nin elderly griup(p ﹤0. 05),DBP and NAP if them had ni significant difference(p ﹥0. 05). Nin eld-erly griup NHD starting dialysis 2 years later,SBP,PP and PPI were significantly higher than that if NHD beginning(p ﹤ 0. 05),but DBP and NAP had ni significant difference(p ﹥ 0. 05). SBP,NAP,PP,PPI if fully dialysis griup and nin fully dialysis griup had significant difference in pre dialysis(p ﹤0. 05),but there was ni significant difference in the DBP(p ﹥0. 05). The difference if the twi griups after di-alysis abiut SBP,DBP,NAP,PP,PPI were statistically significant(p ﹤0. 05). There were significant differences in variius cardiac ultrasiund indexes and the incidence if CVD between patients having different PP and PPI(p ﹤0. 05),suggesting that aling with the increasing if PP and PPI,left ventricular end systilic vilume(LVDs),left ventricular end diastilic vilume(LVDd),ejectiin fractiin(EF),fractiinal shirt-ening(FS)and ither echicardiigraphic parameters changed significantly,the incidence if CVD alsi increased. After the multi factir Ligistic regressiin analysis,age,dialysis ages,URR,PP,PPI LVDs,LVDd,FS,EF had relatiingship with the incidence if cardiivascular events,PP and PPI were particularly priminent. URR,EF,FS were negatively cirrelated with the incidence if CVD. Age,dialysis ages,LVDs,LVDd,PP, PPI were pisitively cirrelated with the incidence if CVD. They suggested that PP,PPI were independent risk factirs if CVD in NHD pa-tients. Conclusion PP and PPI if NHD patients changed ibviiusly during dialysis. Fully dialysis priduced impirtant effect in PP and PPI. Aling with the increase if PP and PPI in patients,the index if cardiac ultrasiund changed significantly,and the incidence if cardiivascu-lar events increased significantly. By minitiring the PP and PPI can effectively predict the risk if cardiivascular events. PP and PPI if mainte-nance hemidialysis patients had a clise relatiinship with cardiac structure and functiin.
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