血透中影响血压变化的因素分析

发布时间：2019-01-11 21:17

【摘要】：目的:为探讨血液透析中患者血压的变化规律,分析血液透析治疗相关参数对病人在透析中血压的影响,特设计了本临床分析研究。本研究采取了回顾性研究方法,对30例维持性血液透析病人透析中血压变化与超滤量、标化的超滤率、透析时段、病人年龄、透析龄、血红蛋白含量、原发病、气虚等不同变量下,血压变化趋势进行了归纳总结分析,探索一些血透病人血压变化的规律。方法:本研究采取了回顾性研究方法,选取了30例规律血透病人在近期36个周的时间段中共计3049例次透析中病情变化,数据记录、病历资料,进行分组对比。根据病人在这36周透析中血压的变化表现,分为低血压组、高血压组和血压稳定组。又分别统计了各组中各个变量的数值,用统计学方法对三组间各变量的均数进行统计学分析,以是否存在统计学差异作为该变量对改组血压变化影响程度的依据进行对比分析。结果:在3049例次血液透析中,依据透析相关低血压、透析相关高血压的诊断标准,对透析中血压的异常变化进行统计,得出结果为:相关低血压发生例次为448例次,占全部透析例次的14.7%,相关高血压发生例次为245例次,占全部透析例次的8.0%,其余透析中血压是稳定的,占77.3%。以低血压组作为观察点来看:总超滤量、标化的超滤率、病人年龄、透析龄等四个变量的均值均大于高血压组和血压稳定组,经统计学检验有显著性差异,而血红蛋白含量的均数低于高血压组和血压稳定组,统计学检验也有显著差异。该结果提示前面三个变量过大和后面一个变量过小,可能是导致低血压发生的重要因素。以高血压组作为观察点来看:总超滤量、标化的超滤率、病人年龄、透析龄、血红蛋白含量这五个指标与低血压组比较前四个低于低血压组,而最后一个高于低血压组,统计学检验均有显著性差异。而与血压稳定组比较,标化超滤量、病人年龄和血红蛋白含量统计学分析有显著差异,而总超滤量变量p值0.05,无统计学意义。在各组组内和组间都看出均数的差异和统计学差异,从趋势上看,透析龄越长,越容易发生低血压;低血压发生的时段是透析期间3-4小时;原发病中糖尿病病人低血压发生率高,原发性肾小球肾炎和原发性高血压更易发生高血压;气虚表现严重者,低血压倾向更加明显。结论:从研究结果中可得出如下结论:1.维持性血液透析治疗中透析相关低血压的发生率为14.7%,透析相关高血压的发生率为8.0%,血压稳定的机率为77.3%;2.在透析中常见变量中:总超滤量和标化的超滤率过大,容易引起低血压。病人年龄越大越容易出现低血压,而越年轻越容易引发高血压。透析龄越长越容易发生低血压,血红蛋白含量越低越容易引起低血压。在原发病中,糖尿病病人更趋于发生低血压,而原发性肾小球肾炎或高血压更趋于发生高血压。在气虚证中,气虚程度越严重,其发生低血压的趋势更明显。
[Abstract]:Objective: to investigate the changes of blood pressure in hemodialysis patients and to analyze the effect of hemodialysis parameters on blood pressure during dialysis. The changes of blood pressure and ultrafiltration volume, standardized ultrafiltration rate, dialysis period, patient age, dialysis age, hemoglobin content, primary disease were studied retrospectively in 30 patients with maintenance hemodialysis. Under different variables such as deficiency of qi, the trend of blood pressure change was summarized and analyzed, and the regularity of blood pressure change in some hemodialysis patients was explored. Methods: in this study, 30 regular hemodialysis patients were selected in the recent 36 weeks in a total of 3049 dialysis changes, data records, medical records, and compared with each other. The patients were divided into hypotension group, hypertension group and stable blood pressure group according to the change of blood pressure during 36 weeks dialysis. The values of each variable in each group were counted, and the mean of each variable was analyzed by statistical method, and the statistical difference was used as the basis for the influence of the variable on the change of blood pressure. Results: according to the diagnostic criteria of dialysation-associated hypotension and dialysation-related hypertension, the abnormal changes of blood pressure in 3049 hemodialysis patients were statistically analyzed. 14.7% of the total dialysis cases, 245 cases of related hypertension, accounting for 8.0% of all dialysis cases, the remaining dialysis blood pressure is stable, accounting for 77.3%. The mean values of total ultrafiltration volume, standardized ultrafiltration rate, patient age and dialysis age in hypotension group were higher than those in hypertension group and stable blood pressure group. The mean of hemoglobin content was lower than that of hypertension group and blood pressure stable group, and there was significant difference in statistical test. The results suggest that the oversize of the first three variables and the small of the latter may be important factors leading to hypotension. The total ultrafiltration rate, standardized ultrafiltration rate, patient age, dialysis age, hemoglobin content in the hypertension group were lower than those in the hypotension group and the first four were lower than those in the hypotension group, while the last was higher than that in the hypotension group. There were significant differences in statistical test. Compared with the stable blood pressure group, there were significant differences in standardized ultrafiltration volume, patient age and hemoglobin content, but the total ultrafiltration variable (p = 0.05) had no statistical significance. We can see the difference of mean and statistical difference in each group and between groups. From the trend, the older the dialysis age, the more prone to hypotension, the period of hypotension is 3-4 hours during dialysis. The incidence of hypotension in patients with primary diabetes mellitus is high, primary glomerulonephritis and essential hypertension are more likely to develop hypertension, and the tendency of hypotension is more obvious in patients with severe qi deficiency. Conclusion: from the results of the study, the following conclusions can be drawn: 1. The incidence of dialysation-related hypotension in maintenance hemodialysis treatment was 14.70.The incidence of dialysation-related hypertension was 8.0 and the probability of blood pressure stabilization was 77.30.The incidence of hemodialysis related hypotension was 14.70.The incidence of dialysation-related hypertension was 8.0%. Among the common variables in dialysis, the total ultrafiltration volume and standardized ultrafiltration rate are too large to cause hypotension. The older the patient is, the more likely he is to develop hypotension, while the younger he is, the more likely he is to develop high blood pressure. The older the dialysis, the more likely to develop hypotension, and the lower the hemoglobin level, the more likely it is to cause hypotension. Diabetic patients tend to develop hypotension, while primary glomerulonephritis or hypertension tend to develop hypertension. In qi deficiency syndrome, the more serious the deficiency of qi, the more obvious the trend of hypotension.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.5

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