血透中影響血壓變化的因素分析
發(fā)布時(shí)間：2019-01-11 21:17
【摘要】：目的:為探討血液透析中患者血壓的變化規(guī)律,分析血液透析治療相關(guān)參數(shù)對病人在透析中血壓的影響,特設(shè)計(jì)了本臨床分析研究。本研究采取了回顧性研究方法,對30例維持性血液透析病人透析中血壓變化與超濾量、標(biāo)化的超濾率、透析時(shí)段、病人年齡、透析齡、血紅蛋白含量、原發(fā)病、氣虛等不同變量下,血壓變化趨勢進(jìn)行了歸納總結(jié)分析,探索一些血透病人血壓變化的規(guī)律。方法:本研究采取了回顧性研究方法,選取了30例規(guī)律血透病人在近期36個(gè)周的時(shí)間段中共計(jì)3049例次透析中病情變化,數(shù)據(jù)記錄、病歷資料,進(jìn)行分組對比。根據(jù)病人在這36周透析中血壓的變化表現(xiàn),分為低血壓組、高血壓組和血壓穩(wěn)定組。又分別統(tǒng)計(jì)了各組中各個(gè)變量的數(shù)值,用統(tǒng)計(jì)學(xué)方法對三組間各變量的均數(shù)進(jìn)行統(tǒng)計(jì)學(xué)分析,以是否存在統(tǒng)計(jì)學(xué)差異作為該變量對改組血壓變化影響程度的依據(jù)進(jìn)行對比分析。結(jié)果:在3049例次血液透析中,依據(jù)透析相關(guān)低血壓、透析相關(guān)高血壓的診斷標(biāo)準(zhǔn),對透析中血壓的異常變化進(jìn)行統(tǒng)計(jì),得出結(jié)果為:相關(guān)低血壓發(fā)生例次為448例次,占全部透析例次的14.7%,相關(guān)高血壓發(fā)生例次為245例次,占全部透析例次的8.0%,其余透析中血壓是穩(wěn)定的,占77.3%。以低血壓組作為觀察點(diǎn)來看:總超濾量、標(biāo)化的超濾率、病人年齡、透析齡等四個(gè)變量的均值均大于高血壓組和血壓穩(wěn)定組,經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn)有顯著性差異,而血紅蛋白含量的均數(shù)低于高血壓組和血壓穩(wěn)定組,統(tǒng)計(jì)學(xué)檢驗(yàn)也有顯著差異。該結(jié)果提示前面三個(gè)變量過大和后面一個(gè)變量過小,可能是導(dǎo)致低血壓發(fā)生的重要因素。以高血壓組作為觀察點(diǎn)來看:總超濾量、標(biāo)化的超濾率、病人年齡、透析齡、血紅蛋白含量這五個(gè)指標(biāo)與低血壓組比較前四個(gè)低于低血壓組,而最后一個(gè)高于低血壓組,統(tǒng)計(jì)學(xué)檢驗(yàn)均有顯著性差異。而與血壓穩(wěn)定組比較,標(biāo)化超濾量、病人年齡和血紅蛋白含量統(tǒng)計(jì)學(xué)分析有顯著差異,而總超濾量變量p值0.05,無統(tǒng)計(jì)學(xué)意義。在各組組內(nèi)和組間都看出均數(shù)的差異和統(tǒng)計(jì)學(xué)差異,從趨勢上看,透析齡越長,越容易發(fā)生低血壓;低血壓發(fā)生的時(shí)段是透析期間3-4小時(shí);原發(fā)病中糖尿病病人低血壓發(fā)生率高,原發(fā)性腎小球腎炎和原發(fā)性高血壓更易發(fā)生高血壓;氣虛表現(xiàn)嚴(yán)重者,低血壓傾向更加明顯。結(jié)論:從研究結(jié)果中可得出如下結(jié)論:1.維持性血液透析治療中透析相關(guān)低血壓的發(fā)生率為14.7%,透析相關(guān)高血壓的發(fā)生率為8.0%,血壓穩(wěn)定的機(jī)率為77.3%;2.在透析中常見變量中:總超濾量和標(biāo)化的超濾率過大,容易引起低血壓。病人年齡越大越容易出現(xiàn)低血壓,而越年輕越容易引發(fā)高血壓。透析齡越長越容易發(fā)生低血壓,血紅蛋白含量越低越容易引起低血壓。在原發(fā)病中,糖尿病病人更趨于發(fā)生低血壓,而原發(fā)性腎小球腎炎或高血壓更趨于發(fā)生高血壓。在氣虛證中,氣虛程度越嚴(yán)重,其發(fā)生低血壓的趨勢更明顯。
[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.
【學(xué)位授予單位】：山東中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R692.5
本文編號：2407456
[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.
【學(xué)位授予單位】：山東中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R692.5
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