泸州市维持性血液透析病人高血压的调查研究

发布时间：2018-09-04 07:13

【摘要】：目的：(1)了解泸州市维持性血液透析（MHD）病人高血压的患病率、知晓率、治疗率和控制率；（2）分析泸州市MHD并高血压病人血压控制不佳的影响因素。方法：(1)对2013年6～10月于泸州市3个大型医院血液透析（HD）中心行MHD并符合入选标准的237例病人开展调查研究，分析MHD病人高血压的患病、知晓、治疗以及控制情况。（2）将MHD并高血压病人分为血压控制不佳组和血压控制满意组，研究年龄、性别、透析龄、干体重、HD前血钙、镁、磷、钠浓度、血红蛋白、甲状旁腺激素（PTH）、血脂、Kt/V、促红细胞生成素（EPO）用量、HD频率、血液透析滤过（HDF）频率、血液灌流（HP）频率、透析器、抗凝剂、降压药种类以及钙磷乘积与MHD并高血压病人血压控制不佳的关系，并进行多因素Logistic回归分析，寻找MHD并高血压病人血压控制不佳的影响因素。结果：(1)泸州市MHD病人高血压的患病率为94.9％，其中男性高血压患病率为93.6%，女性为96.9%，女性高血压患病率较男性高，但差异无统计学意义；青年、中年及老年高血压患病率分别为93.4%、96.8%、92.0%，中年患病率更高，但差异也无统计学意义。(2)泸州市MHD病人高血压的知晓率及治疗率均为99.6％。进行降压治疗的病人中选用钙通道阻滞剂(CCB)者最多，占92.9％；其中使用1种、2种、3种、4种及5种降压药物者分别占22.4％、34.2％、32.9％、6.2％及1.8％；使用1种降压药物的病人中，应用CCB者占81.8％；使用2种降压药物的病人中，CCB与血管紧张素转换酶抑制剂(ACEI)或血管紧张素II受体阻滞剂(ARB)和β受体阻滞剂联合使用者分别占46.8％和37.7％。(3)泸州市MHD并高血压病人的血压控制率为29.3%，有70.7%的病人即使接受降压治疗，血压也未能得到有效的控制，血压控制不佳的病人中血压为1级高血压水平者占62.9%，2级高血压水平者占29.6%，3级高血压水平者占7.5%；血压为单纯收缩期高血压者占48.4％，，混合型高血压者占49.7％，只有1.9％为单纯舒张期高血压；男性和女性高血压的控制率分别为28.2％和30.9％，女性高血压的控制率较高，但差异无统计学意义；青年、中年、老年病人高血压的控制率分别为31.6％、27.9％及30.4％，青年病人高血压的控制率较中年及老年高，但差异无统计学意义；原发病为高血压性肾损害、慢性肾小球肾炎和糖尿病肾病的病人高血压控制率分别为45.9％、23.5％和22.9％，原发病为高血压性肾损害的病人高血压的控制率较原发病为慢性肾小球肾炎和糖尿病肾病者高，差异有统计学意义；使用1种、2种、3种或3种以上降压药物的病人高血压的控制率分别为34.5%、32.5%、23.9%，随着用药种类的增加，高血压的控制率也逐渐降低，但差异无统计学意义。(4)泸州市MHD并高血压病人中血压控制不佳组病人的干体重达标率低于血压控制满意组，而HD前血钠浓度≥140mmol/L的比例、EPO用量≥150U/kg w的比例、PTH≥150ng/dl的比例、Kt/V＜1.2的比例、HD频率＜10小时/周的比例以及HP频率＜2小时/月的比例均大于血压控制满意组，两组比较差异存在统计学意义，而年龄、透析龄、HD前血钙、磷、镁浓度、血红蛋白浓度、血脂异常比例、HDF频率＜8小时/月比例、选择高通量透析器比例、选择低分子肝素为抗凝剂的比例以及钙磷乘积≥55mg2/dl2的比例均无统计学意义。多因素Logistic回归分析显示，MHD并高血压病人血压控制不佳与干体重、血PTH水平、Kt/V、HD前血钠浓度、HD及HP频率相关。结论：(1)泸州市MHD病人高血压的患病率、知晓率、治疗率均高，但是控制率较低。(2)干体重未达标、血PTH≥150ng/L、Kt/V＜1.2、HD前血钠浓度≥140mmol/L、HD频率＜10小时/周及HP频率＜2小时/月是泸州市MHD并高血压病人血压控制不佳的影响因素，同时降压药物应用不够规范也是血压控制不佳的重要原因。
[Abstract]:Objective: (1) To understand the prevalence, awareness rate, treatment rate and control rate of hypertension in patients with maintenance hemodialysis (MHD) in Luzhou City; (2) To analyze the influencing factors of poor blood pressure control in patients with MHD and hypertension in Luzhou City. (1) To perform MHD in three large-scale hospitals of Luzhou from June to October 2013 and meet the selected criteria. A total of 237 patients with MHD were investigated and analyzed for the prevalence, awareness, treatment and control of hypertension. (2) MHD patients with hypertension were divided into two groups: poor blood pressure control group and satisfactory blood pressure control group. Erythropoietin (EPO) dosage, HD frequency, hemodiafiltration (HDF) frequency, hemoperfusion (HP) frequency, dialyzers, anticoagulants, antihypertensive drugs and calcium-phosphorus product were associated with poor blood pressure control in MHD patients with hypertension. Multivariate logistic regression analysis was performed to find out the influencing factors of poor blood pressure control in MHD patients with hypertension. Results: (1) The prevalence of hypertension in MHD patients in Luzhou was 94.9%. The prevalence of hypertension was 93.6% in males and 96.9% in females. The prevalence of hypertension in females was higher than that in males, but the difference was not statistically significant. (2) The awareness rate and treatment rate of hypertension in MHD patients in Luzhou were 99.6%. Calcium channel blockers (CCB) were the most frequently used in patients undergoing antihypertensive therapy, accounting for 92.9%. Among them, 22.4%, 34.2%, 32.9%, 6.2% and 1.8% used one, two, three, four and five antihypertensive drugs, respectively. CCB accounted for 81.8%; among the patients who used two kinds of antihypertensive drugs, 46.8% and 37.7% used CCB in combination with angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) and beta receptor blocker respectively. (3) The blood pressure control rate of MHD patients with hypertension in Luzhou was 29.3%, and 70.7% patients even received antihypertensive therapy. In the patients with poor blood pressure control, 62.9% of them had Grade 1 hypertension, 29.6% had Grade 2 hypertension, 7.5% had Grade 3 hypertension, 48.4% had simple systolic hypertension, 49.7% had mixed hypertension, and only 1.9% had diastolic hypertension. The control rate of hypertension in young, middle-aged and elderly patients was 31.6%, 27.9% and 30.4%, respectively. The control rate of hypertension in young patients was higher than that in middle-aged and elderly patients, but there was no significant difference. The control rate of hypertension was 45.9%, 23.5% and 22.9% in patients with chronic glomerulonephritis and diabetic nephropathy, respectively. The control rate of hypertension in patients with primary hypertension was higher than that in patients with primary hypertension and diabetic nephropathy, the difference was statistically significant. The control rate of hypertension was 34.5%, 32.5% and 23.9% respectively in patients with one or more kinds of antihypertensive drugs. The control rate of hypertension gradually decreased with the increase of drug types, but the difference was not statistically significant. (4) The rate of dry weight in patients with poor blood pressure control in MHD patients with hypertension in Luzhou was lower than that in patients with satisfactory blood pressure control, but before HD. The proportion of serum sodium concentration (> 140 mmol / L), EPO dosage (> 150 U / kg w), PTH (> 150 ng / dl), Kt / V < 1.2, HD frequency < 10 hours / week and HP frequency < 2 hours / month were all higher than those in the control group. There were significant differences between the two groups. Age, dialysis age, serum calcium, phosphorus, magnesium concentration before HD, and serum calcium, phosphorus, magnesium concentration before HD were also higher than those in the control group. There were no significant differences in erythrocyte concentration, proportion of dyslipidemia, frequency of HDF less than 8 hours/month, proportion of high-throughput dialyzers, ratio of low-molecular-weight heparin as anticoagulant, and ratio of calcium-phosphorus product (>55 mg 2/dl2). Multivariate logistic regression analysis showed that poor blood pressure control, dry weight and PTH level were associated with MHD and hypertension. Conclusion: (1) The prevalence, awareness rate and treatment rate of hypertension in MHD patients in Luzhou are high, but the control rate is low. (2) Dry weight is not up to the standard, PTH < 150 ng / L, Kt / V < 1.2, serum sodium concentration < 140 mmol / L before HD, HD frequency < 10 hours / week and HP frequency < 2 hours / month are MHD patients with hypertension in Luzhou. Influencing factors of poor blood pressure control and insufficient use of antihypertensive drugs are also important reasons for poor blood pressure control.
【学位授予单位】：泸州医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692.5;R544.1

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