血液透析血压及其变异性与患者预后的相关性分析

目的:探讨血液透析前后和血液透析过程中血压及其变异性与患者预后的相关性。方法:选取沈阳军区总医院血液透析中心2010年1月1日至2013年12月31日收治的维持性血液透析患者,收集并对比随访期内生存及死亡患者的自然信息及临床资料,评估血液透析过程中患者血压及其变异程度与患者预后的关系。结果:共有269例患者纳入研究,经过4年随访共死亡83(30.86%)例。死亡组年龄显著大于存活组(64.92±13.24岁比49.89±12.86岁,P=0.000),而透析年限显著短于存活组(2.60±2.56年比7.25±4.14年,P=0.000)。死亡组透析前SBP(P=0.001)、DBP(P=0.000)、MAP(P=0.000)均显著高于存活组。两组间透析后SBP、DBP、MAP比较均无显著差异。死亡组△SBP(P=0.026)、△DBP(P=0.001)、△MAP(P=0.001)幅度显著大于存活组。死亡组透析前SBP变异率显著高于存活组(P=0.001);死亡组透析后SBP变异率(P=0.000)、DBP变异率(P=0.014)、MAP变异率(P=0.005)均高于存活组。死亡组每次透析前各时间点间SBP变异率(0.12±0.04 mm Hg比0.09±0.03 mm Hg,P=0.000)与MAP变异率(0.10±0.03mm Hg比0.09±0.03 mm Hg,P=0.001)显著高于非死亡组。结论:维持性血液透析患者透析前血压、透析前后血压改变幅度、透析前后血压变异率、每次透析各时间点间血压变异率等与全因死亡相关。

Analysis of the Association between Blood Pressure Variability during Dialysis and Prognosis of Patients treated by Maintenance Haemodialysis

Objective:To determine the association between blood pressure variability during dialysis and prognosis of patients treated by maintenance haemodialysis.Methods:A longitudinal observational study of patients commencing haemodialysis from 2010 to 2013 in our blood purification center was performed. The relationship between blood pressure variability during dialysis and mortality was assessed.Results:Of 269 patients enrolled, 83 (30.86%) patients died during the follow-up of 4 years. Pre-dialytic SBP(P=0.001), DBP (P=0.000), MAP (P=0.000) were significantly higher in the death group. No significant difference was found in Post-dialytic SBP, DBP and MAP between the two groups. Post-dialytic drops in SBP(P=0.026), DBP(P=0.001) and MAP(P=0.001) were more significant in death gourp. Coefficient of variation in pre-dialytic SBP (P=0.001), Post-dialytic SBP (P=0.000), DBP (P=0.014) and MAP(P=0.005) were significantly higher in the death group. Coefficient of variation in SBP(P=0.000) and MAP(P=0.001) were significantly higher in the death group.Conclusion:Our study shows that pre-dialysis systolic blood pressure, blood pressure variability during dialysis were associated with all-cause mortality of patients treated by maintenance haemodialysis.