怀孕了梦见自己又结婚:透析中低血压和血管通路血栓形成的关系

Journal of the American Society of Nephrology : JASN.2011-08;22(8):1526-33.

临床试验 PUBMED链接：PMID 21803971

Identifying potential modifiable risk factors to reduce the incidence of vascular access thrombosis in hemodialysis could reduce considerable morbidity and health care costs. We analyzed data from a subset of 1426 HEMO study subjects to determine whether more frequent intradialytic hypotension and/or lower predialysis systolic BP were associated with higher rates of vascular access thrombosis. Our primary outcome measure was episodes of vascular access thrombosis occurring within a given 6-month period during HEMO study follow-up. There were 2005 total episodes of vascular access thrombosis during a median 3.1 years of follow-up. The relative rate of thrombosis of native arteriovenous fistulas for the highest quartile of intradialytic hypotension was approximately twice that of the lowest quartile, independent of predialysis systolic BP and other covariates. There was no significant association of intradialytic hypotension with prosthetic arteriovenous graft thrombosis after multivariable adjustment. Higher predialysis systolic BP was associated with a lower rate of fistula and graft thrombosis, independent of intradialytic hypotension and other covariates. In conclusion, more frequent episodes of intradialytic hypotension and lower predialysis systolic BP associate with increased rates of vascular access thrombosis. These results underscore the importance of including vascular access patency in future studies of BP management in hemodialysis.

Adolescent; Adult; Aged; Aged, 80 and over; Blood Pressure; Cohort Studies; Female; Fistula; Follow-Up Studies; Humans; Hypotension; Kidney Failure, Chronic; Male; Middle Aged; Models, Biological; Renal Dialysis; Thrombosis; Vascular Patency;

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1. lhm8876

   评级： 2011-10-20 13:55

   最近有学者利用HEMO研究的数据，作了一项关于透析期间低血压与血管通路血栓形成关系的研究，研究终点为血管通路血栓形成，以6个月作为一个周期，1426例血液透析患者平均随访3.1年后，共有2005个透析周期。将透析期间出现低血压的几率分成四等分，结果显示，校正透析前血压等因素后，最高四分位低血压几率的自体动静脉内漏血栓形成是最低四分位低血压几率的两倍，即低血压发生率越高，自体动静脉内漏血栓形成的风险越高，但在人工血管动静脉内漏中，低血压发生率的高低与内漏血栓形成无显著相关，另外透析前有较高收缩压，自体和人工血管动静脉内漏血栓形成的风险均较低，且与透析期间低血压发生率高低等因素无关。因此，透析期间低血压和透析前收...