合并体位性低血压对维持性血液透析患者预后的影响

目的评估体位性低血压（OH）对维持性血液透析患者预后的指示意义。方法分析评估2004—2007年62例维持性血液透析患者OH与其他因素导致患者死亡的关系。参试患者进入试验时一般状态稳定，每次血液透析治疗前连续进行5次血压测定。OH定义：从卧位变为立位后肱动脉收缩压下降大于20mmHg（1mmHg=0．133kPa）或舒张压下降大于10mmHg。结果62例患者中，35．5％（22／62）存在不同程度的OH。在平均（35．0±47．6）周（1～140周）的随访期间，共记录到7例患者死亡。使用多变量COX比例危险率回归模型分析表明患者年龄、存在OH和既往有脑血管基础疾病史是患者远期预后（死亡）的独立预测因素。同时，使用Kaplan—Meier生存分析法判断所有参试患者存在和不存在OH的远期预后，发现差异均有统计学意义。结论血液透析患者开始出现OH是标志患者远期预后（各种原因导致死亡）的独立指示因素。

Effect of orthostatic hypotension on prognosis of patients with maintenance haemodialysis

Objective To evaluate the predictive value of orthostatic hypotension （OH） in the patients with maintenance haemodialysis. Methods All of 62 patients in stable condition were enrolled. More than 5 consecutive blood pressure measurements before haemodialysis treatment was made on each patients. OH was defined as systolic blood pressure descended 〉 20 mm Hg （1 mm Hg = 0.133 kPa） or diastolic blood pressure descended 〉 10 mm Hg. Results Of 62 patients, 35.5%（22/62） had OH. During a mean follow-up of （35.0 ± 47.6） weeks （range 1-140 weeks）, 7 deaths were recorded. A multivariate COX proportional hazards model analysis demonstrated that age, OH and past history of cerebrovascular disease were independent predictors of all-cause death. The comparison by Kaplan-Meier analysis of the survival showed that there was significant difference between patients with and without OH. Conclusion At the introductory phase of haemodialysis, OH is an independent predictor of survival rate in haemodialysis patients.