目的:探讨血液透析患者治疗过程中高血压的发病情况和治疗措施. 方法:回顾性分析北京大学人民医院血液透析中心2008年1月～2009年6月维持性血液透析(MHD)患者发生透析中高血压(intradialytic hypertension,IDH)的临床资料,观察加强超滤脱水、调整降压药和改变透析液钙离子浓度等方法对IDH患者透析前后及透析中血压变化的影响. 结果:131例MHD患者中23例(17.5％)发生IDH,其中18例通过加强超滤脱水后,透析前收缩压、透析3h、透析4h平均动脉压(MAP)及透析后的收缩压、舒张压、MAP均较治疗前显著下降(P＜0.05),IDH的发生率显著减低(P＜0.01).2例患者改用钙离子浓度为1.25 mmol/L的透析液透析后血清钙离子浓度较调整前下降,透析前、后的血压较前降低,同时未再发生IDH.另3例患者通过调整降压药剂量和种类使透析前、后血压和IDH得到控制. 结论:容量超负荷可能是MHD患者发生IDH的主要原因,通过增加超滤、调整透析液钙离子浓度和服降压药有助控制IDH的发生.%Objective: To analyze the clinical data of intradialytic hypertension ( IDH) and its management in patients with maintenance hemodialysis (MHD). Methodology: The clinical records of twenty three MHD patients with intradialytic hypertension in a single blood purification center in the past 18 months were retrospectively studied. They were treated with repeated intensive ultrafiltration ( UF), dialysate of lower calcium concentration or adjustment of antihypertensive medications. The outcomes of the therapeutic measures were analyzed. Results; In our study, 23 (17.5%) of 131 maintenance hemodialysis patients had IDH. After a treatment period of intensive UF, predialysis systolic blood pressure (SBP), intradialysis mean arterial blood pressure (MAP), postdialysis SBP, diastolic blood pressure (DBP) and MAP(P<0. 05 or P<0.01) decreased respectively in 18 patients, with a significantly decreased incidence of IDH (P < 0. 01). The dialysate containing Ca2+ 1. 25 mmol/L deceased predialysis and postdialysis BP and controlled the IDH in 2 patients. In 3 patients of adjusted antihypertensive drugs dosage or types, both predialysis BP and postdialysis BP were controlled,with the absence of IDH. Conclusion: Volume overload may play a major role in the pathophysiology of intradialytic hypertension in maintenance hemodialysis patients. Rigid regulation of intravascular volume, adjustment of antihypertensive medications and change of electrolyte in dialysate may favorable in control of intradialytic hypertension.
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