上海交通大学学报（医学版）

›› 2011, Vol. 31 ›› Issue (10): 1419-.doi: 10.3969/j.issn.1674-8115.2011.10.013

• 论著（临床研究） • 上一篇    下一篇

维持性血液透析患者血浆容量与血压关系的研究

方 燕, 张伟明, 严玉澄, 陆任华, 王咏梅, 朱铭力, 倪兆慧, 钱家麒   

  1. 上海交通大学 医学院附属仁济医院肾脏科, 上海 200001
  • 出版日期:2011-10-28 发布日期:2011-10-27
  • 通讯作者: 张伟明, 电子信箱: weiming1965@yahoo.com.cn。
  • 作者简介:方 燕（1979—）, 女, 住院医师, 硕士生；电子信箱: fangyan_fyfy@126.com。

Clinical study on relationship between plasma volume and blood pressure in patients undergoing chronic hemodialysis

FANG Yan, ZHANG Wei-ming, YAN Yu-cheng, LU Ren-hua, WANG Yong-mei, ZHU Ming-li, NI Zhao-hui, QIAN Jia-qi   

  1. Renal Division, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200001, China
  • Online:2011-10-28 Published:2011-10-27

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摘要：

目的 探讨维持性血液透析患者透析过程中血浆容量变化与血压的关系。方法 36例维持性血液透析患者根据透析前血压水平分为正常血压组（n=16）和高血压组（n=20）。记录透析前后患者的血压和体质量，检测血清总蛋白水平并计算血浆容量变化值（△PV）。所有数据采用SPSS 13.0软件进行统计学分析。结果 在正常血压组，透析前后收缩压分别为（123.3±19.9） mmHg （1 mmHg=0.133 kPa）和（122.3±27.0）mmHg，舒张压分别为(69.6±9.2) mmHg和(70.9±17.0) mmHg，透析前后收缩压和舒张压比较差异均无统计学意义（P>0.05）；透析过程中，体质量变化值为（2.7±1.4）kg，△PV为（14.7±10.8）%。在高血压组，透析前后收缩压分别为（162.6±16.2） mmHg和（148.2±31.1）mmHg，透析前后舒张压分别为(86.6±9.6) mmHg和(82.1±14.4) mmHg，透析后收缩压较透析前显著下降（P<0.05）,而透析前后舒张压比较差异无统计学意义（P>0.05）；透析过程中，体质量变化值为（3.2±1.3）kg，△PV为（20.4±14.4）%。相关性分析结果显示：正常血压组和高血压组患者透析前后血压与透析过程中的△PV和体质量变化均无显著相关性（P>0.05）。结论 透析过程中，血浆容量改变未对患者透析前后血压变化产生显著影响；体质量下降尚不足以确切反映患者血浆容量状态，且用于预示透析前后血压变化的作用有限。

关键词: 维持性血液透析, 血浆容量, 血压, 体质量

Abstract:

Objective To explore the association between plasma volume and blood pressure during hemodialysis in patients undergoing chronic hemodialysis. Methods Thirty-six patients undergoing chronic hemodialysis were divided into normotensive group (n=16) and hypertensive group (n=20) according to blood pressure before hemodialysis. The blood pressure and body weight before hemodialysis and after hemodialysis were recorded, and serum total protein concentrations were measured to determine the changes of plasma volumes (△PV). Statistical analysis was performed with SPSS 13.0 software. Results In normotensive group, the systolic pressure was (123.3±19.9) mmHg (1 mmHg=0.133 kPa) before hemodialysis and (122.3±27.0) mmHg after hemodialysis, the diastolic pressure was (69.6±9.2) mmHg before hemodialysis and (70.9±17.0) mmHg after hemodialysis, and there was no significant difference between systolic pressure and diastolic pressure before hemodialysis and those after hemodialysis (P>0.05). During hemodialysis in normotensive group, the change of body weight was (2.7±1.4) kg, and △PV was (14.7±10.8)%. In hypertensive group, the systolic pressure was (162.6±16.2) mmHg before hemodialysis and （148.2±31.1）mmHg after hemodialysis, the diastolic pressure was (86.6±9.6) mmHg before hemodialysis and (82.1±14.4) mmHg after hemodialysis, the systolic pressure after hemodialysis was significantly lower than that before hemodialysis (P<0.05), while there was no significant difference between diastolic pressure before hemodialysis and that after hemodialysis (P>0.05). During hemodialysis in hypertensive group, the change of body weight was (3.2±1.3) kg, and △PV was (20.4±14.4)%. Correlation analysis revealed that blood pressure before hemodialysis and after hemodialysis in hypertensive group and normotensive group was not significantly related to △PV and changes of body weight during hemodialysis (P>0.05). Conclusion During hemodialysis, changes in plasma volume do not influence changes in blood pressure before hemodialysis and after hemodialysis, and reduction in body weight is insufficient to reflect the changes of plasma volume and may be of limited effect to predict the changes in blood pressure before hemodialysis and after hemodialysis.

Key words: chronic hemodialysis, plasma volume, blood pressure, body weight