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目的探索基于不同病因的个体化治疗模式对改善血液透析(HD)患者高血压控制率的影响。方法选取我院部分稳定维持性HD患者进行家庭血压(Home-BP)监测,以家庭血压的收缩压(Home-SBP)≥150mmHg为未控制的高血压的诊断标准,对入组高血压患者进行干预研究。行生物电阻抗检测,血清钠测定,药物使用情况调查,了解水、钠负荷及药物应用合理性情况,有针对性地分别进行降低干体重、低钠透析和合理使用降压药物的干预措施。随访2个月,观察患者高血压控制情况。结果 105例稳定维持性HD患者接受了Home-BP监测,其中未控制的高血压患者60例(57.1%)。其中30例患者容量超负荷,针对性地降低干体重后,Home-SBP下降12.0mmHg(P<0.001),家庭血压的舒张压(Home-DBP)下降5.0mmHg(P=0.002),降压药用量显著减少(P=0.030)。12例透析前血钠低于标准透析液钠浓度(138mmol/L)的患者使用低钠透析(136mmol/L)后,Home-SBP下降14.0mmHg(P=0.003),Home-DBP下降8.1mmHg(P=0.014),降压药用量无明显变化(P=0.390)。余18例患者通过增加肾素-血管紧张素抑制剂和抗交感治疗,Home-SBP下降11.6mmHg(P<0.001),Home-DBP下降4.2mmHg(P=0.021)。通过上述治疗,患者未控制的高血压比例从57.1%(60例)降至31.4%(33例)(P<0.001)。结论对HD高血压患者进行有针对性的、个体化的干预治疗措施,能够有效地改善HD高血压患者血压状况。
Objective To explore the effects of individualized treatment based on different etiologies on the improvement of hypertension control rate in hemodialysis (HD) patients. Methods Home-BP monitoring was performed in some stable and maintenance HD patients in our hospital. Home-BP was used as diagnostic criteria for uncontrolled hypertension with Home-SBP ≥150mmHg Intervention study. Line bioelectric impedance test, serum sodium determination, drug use survey, understand the water, sodium load and the rationality of drug use, respectively, targeted to reduce dry weight, low sodium dialysis and rational use of antihypertensive drugs interventions. Follow-up 2 months, observe the control of patients with hypertension. Results Home-BP monitoring was performed in 105 stable maintenance HD patients, of whom 60 (57.1%) had uncontrolled hypertension. Among 30 patients, the Home-SBP decreased by 12.0 mmHg (P <0.001), the Home-DBP decreased by 5.0 mmHg (P = 0.002), and the antihypertensive drugs Significant reduction in dosage (P = 0.030). Home-SBP decreased by 14.0 mmHg (P = 0.003) and Home-DBP decreased by 8.1 mmHg (P = 0.003) after treatment with low sodium dialysis (136 mmol / L) in 12 patients with pre-dialysis serum sodium lower than the standard dialysate sodium concentration P = 0.014), no significant changes in the amount of antihypertensive drugs (P = 0.390). Home-SBP decreased by 11.6 mmHg (P <0.001) and Home-DBP decreased by 4.2 mmHg (P = 0.021) by adding renin-angiotensin inhibitor and anti-sympathetic treatment in the remaining 18 patients. Through this treatment, the proportion of patients with uncontrolled hypertension decreased from 57.1% (60 cases) to 31.4% (33 cases) (P <0.001). Conclusions Targeted and individualized interventions for HD patients can effectively improve the blood pressure status in HD patients.