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目的了解维持性血液透析(MHD)患者透析间期体重增长率(PIWG)与透析前及透析后血压波动的关系。方法共纳入规律血液透析6个月以上,每周3次透析,18岁及以上成年患者72例,男39例(54.17%),女33例,平均年龄(64.38±13.28)(29～82)岁,平均透析龄(4.12±4.28)(0.5～20)年。测定MHD患者透析前体重,计算超滤量(UF)(透析前体重-前次透析后体重)及PIWG[(透析前体重-前次透析后体重)/干体重×100%]。测定患者透析前血压、透析中每小时血压及透析后血压,并计算收缩压(SBP)差值(dSBP)(透析前SBP-透析后SBP)。收集4周内,共计942例次血液透析治疗,筛选795组完整有效数据。结果入选患者平均干体重为(62.83±11.84)kg,平均超滤量为(3.01±0.85)L,平均PIWG为4.85%±1.24%。透析前SBP(151.20±23.63)mmHg,透析后SBP(146.27±26.58)mmHg,差异有统计学意义(P<0.001)。相关分析显示,PIWG与透析前SBP(P=0.038)及dSBP(P<0.001)呈正相关,而与透析后SBP呈负相关(P<0.001)。透析间期体重每增长1%,则透析前SBP增加1.72mmHg(P=0.038,95% CI0.093～3.347),透析后SBP下降4.278mmHg(P<0.001,95%CI-6.076～-2.477),dSBP增加5.998mmHg(P<0.001,95% CI4.166～7.830)。结论 PIWG与透析前SBP及dSBP呈正相关,与透析后SBP呈负相关。容量负荷的变化对SBP的影响比舒张压大。
Objective To investigate the relationship between the inter-dialysis weight gain (PIWG) and pre-dialysis and post-dialysis blood pressure fluctuations in maintenance hemodialysis (MHD) patients. Methods A total of 72 adult patients aged 18 and over were enrolled in the regular hemodialysis for more than 6 months, dialysis 3 times per week, 39 males (54.17%) and 33 females (mean age, 64.38 ± 13.28) (29-82) Years old, average dialysis age (4.12 ± 4.28) (0.5 ~ 20) years. The pre-dialysis weight was measured in patients with MHD and the UF (weight before dialysis - weight after previous dialysis) and PIWG [(weight before dialysis - weight after previous dialysis) / dry weight × 100%] were calculated. Pre-dialysis blood pressure, hourly dialysis dialysis blood pressure and post-dialysis blood pressure were measured and systolic blood pressure (SBP) difference (dSBP) was calculated (SBP-before dialysis SBP). A total of 942 hemodialysis treatments were collected within 4 weeks, and 795 complete validated data were screened. Results The average dry body weight of selected patients was (62.83 ± 11.84) kg, the average ultrafiltration volume was (3.01 ± 0.85) L, the average PIWG was 4.85% ± 1.24%. Pre-dialysis SBP (151.20 ± 23.63) mmHg, after dialysis SBP (146.27 ± 26.58) mmHg, the difference was statistically significant (P <0.001). Correlation analysis showed that PIWG was positively correlated with pre-dialysis SBP (P = 0.038) and dSBP (P <0.001), but negatively with SBP after dialysis (P <0.001). For each 1% increase in dialysis interval, pre-dialysis SBP increased 1.72mmHg (P = 0.038,95% CI0.093 ~ 3.347), after dialysis SBP decreased 4.278mmHg (P <0.001,95% CI-6.076 ~ -2.477) , dSBP increased 5.998 mmHg (P <0.001, 95% CI 4.166-7.830). Conclusions PIWG is positively correlated with SBP and dSBP before dialysis, and negatively with SBP after dialysis. Changes in volume load on SBP greater than diastolic blood pressure.