發(fā)布時間：2018-09-04 07:13

【摘要】：目的：(1)了解瀘州市維持性血液透析（MHD）病人高血壓的患病率、知曉率、治療率和控制率；（2）分析瀘州市MHD并高血壓病人血壓控制不佳的影響因素。方法：(1)對2013年6～10月于瀘州市3個大型醫(yī)院血液透析（HD）中心行MHD并符合入選標(biāo)準(zhǔn)的237例病人開展調(diào)查研究，分析MHD病人高血壓的患病、知曉、治療以及控制情況。（2）將MHD并高血壓病人分為血壓控制不佳組和血壓控制滿意組，研究年齡、性別、透析齡、干體重、HD前血鈣、鎂、磷、鈉濃度、血紅蛋白、甲狀旁腺激素（PTH）、血脂、Kt/V、促紅細(xì)胞生成素（EPO）用量、HD頻率、血液透析濾過（HDF）頻率、血液灌流（HP）頻率、透析器、抗凝劑、降壓藥種類以及鈣磷乘積與MHD并高血壓病人血壓控制不佳的關(guān)系，并進行多因素Logistic回歸分析，尋找MHD并高血壓病人血壓控制不佳的影響因素。結(jié)果：(1)瀘州市MHD病人高血壓的患病率為94.9％，其中男性高血壓患病率為93.6%，女性為96.9%，女性高血壓患病率較男性高，但差異無統(tǒng)計學(xué)意義；青年、中年及老年高血壓患病率分別為93.4%、96.8%、92.0%，中年患病率更高，但差異也無統(tǒng)計學(xué)意義。(2)瀘州市MHD病人高血壓的知曉率及治療率均為99.6％。進行降壓治療的病人中選用鈣通道阻滯劑(CCB)者最多，占92.9％；其中使用1種、2種、3種、4種及5種降壓藥物者分別占22.4％、34.2％、32.9％、6.2％及1.8％；使用1種降壓藥物的病人中，應(yīng)用CCB者占81.8％；使用2種降壓藥物的病人中，CCB與血管緊張素轉(zhuǎn)換酶抑制劑(ACEI)或血管緊張素II受體阻滯劑(ARB)和β受體阻滯劑聯(lián)合使用者分別占46.8％和37.7％。(3)瀘州市MHD并高血壓病人的血壓控制率為29.3%，有70.7%的病人即使接受降壓治療，血壓也未能得到有效的控制，血壓控制不佳的病人中血壓為1級高血壓水平者占62.9%，2級高血壓水平者占29.6%，3級高血壓水平者占7.5%；血壓為單純收縮期高血壓者占48.4％，，混合型高血壓者占49.7％，只有1.9％為單純舒張期高血壓；男性和女性高血壓的控制率分別為28.2％和30.9％，女性高血壓的控制率較高，但差異無統(tǒng)計學(xué)意義；青年、中年、老年病人高血壓的控制率分別為31.6％、27.9％及30.4％，青年病人高血壓的控制率較中年及老年高，但差異無統(tǒng)計學(xué)意義；原發(fā)病為高血壓性腎損害、慢性腎小球腎炎和糖尿病腎病的病人高血壓控制率分別為45.9％、23.5％和22.9％，原發(fā)病為高血壓性腎損害的病人高血壓的控制率較原發(fā)病為慢性腎小球腎炎和糖尿病腎病者高，差異有統(tǒng)計學(xué)意義；使用1種、2種、3種或3種以上降壓藥物的病人高血壓的控制率分別為34.5%、32.5%、23.9%，隨著用藥種類的增加，高血壓的控制率也逐漸降低，但差異無統(tǒng)計學(xué)意義。(4)瀘州市MHD并高血壓病人中血壓控制不佳組病人的干體重達標(biāo)率低于血壓控制滿意組，而HD前血鈉濃度≥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頻率＜10小時/周的比例以及HP頻率＜2小時/月的比例均大于血壓控制滿意組，兩組比較差異存在統(tǒng)計學(xué)意義，而年齡、透析齡、HD前血鈣、磷、鎂濃度、血紅蛋白濃度、血脂異常比例、HDF頻率＜8小時/月比例、選擇高通量透析器比例、選擇低分子肝素為抗凝劑的比例以及鈣磷乘積≥55mg2/dl2的比例均無統(tǒng)計學(xué)意義。多因素Logistic回歸分析顯示，MHD并高血壓病人血壓控制不佳與干體重、血PTH水平、Kt/V、HD前血鈉濃度、HD及HP頻率相關(guān)。結(jié)論：(1)瀘州市MHD病人高血壓的患病率、知曉率、治療率均高，但是控制率較低。(2)干體重未達標(biāo)、血PTH≥150ng/L、Kt/V＜1.2、HD前血鈉濃度≥140mmol/L、HD頻率＜10小時/周及HP頻率＜2小時/月是瀘州市MHD并高血壓病人血壓控制不佳的影響因素，同時降壓藥物應(yīng)用不夠規(guī)范也是血壓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.
【學(xué)位授予單位】：瀘州醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R692.5;R544.1

【參考文獻】

相關(guān)期刊論文 前9條

1 黃錦文;趙冰峰;梁素心;楊友蓮;;樹脂灌血液灌流在頑固性高血壓患者血液透析中的應(yīng)用[J];現(xiàn)代生物醫(yī)學(xué)進展;2011年11期

2 張靜;王梅;;維持性血液透析患者透析中高血壓的臨床分析[J];腎臟病與透析腎移植雜志;2011年06期

3 白亞玲;徐金升;孫利軍;張俊霞;崔立文;張勝雷;;維持性血液透析中并發(fā)高血壓患者血清ET-1、NO水平變化[J];山東醫(yī)藥;2013年18期

4 潘陽彬;萬建新;崔炯;郭淑霞;;血液灌流對維持性血液透析患者難治性高血壓短期治療的觀察[J];中華高血壓雜志;2008年03期

5 ;中國成人血脂異常防治指南[J];中華心血管病雜志;2007年05期

6 王虹;何東元;牟利軍;;維持性血液透析患者的血壓與透析充分性及相關(guān)因素分析[J];心腦血管病防治;2013年03期

7 馮穎青;李勇;張宇清;王浩;陳源源;孫忠實;李悅;王鴻懿;謝良地;高平進;李南方;孫英賢;李新立;嚴(yán)曉偉;陳曉平;趙連友;孫寧玲;;β受體阻滯劑在高血壓應(yīng)用中的專家指導(dǎo)建議[J];中國醫(yī)學(xué)前沿雜志(電子版);2013年04期

8 徐玉祥;周青溢;孫巨軍;肖鵬;賀曉雯;張九芝;范麗;楊少偉;;樹脂吸附對維持性血液透析難治性高血壓患者腎素—血管緊張素—醛固酮系統(tǒng)的影響[J];中國血液凈化;2013年06期

9 施仲偉;;β受體阻滯劑治療高血壓臨床療效再評價[J];醫(yī)學(xué)研究雜志;2013年07期

本文編號：2221372