nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2009-13-2-42-49nefr-1160Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ. КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯORIGINAL ARTICLES. CLINICAL INVESTIGATIONSДИНАМИКА АРТЕРИАЛЬНОГО ДАВЛЕНИЯ И ЕГО СУТОЧНОГО ПРОФИЛЯ У ПАЦИЕНТОВ НА СТАНДАРТНОМ ПРОГРАММНОМ ГЕМОДИАЛИЗЕ: ДАННЫЕ ДВУХСУТОЧНОГО МОНИТОРИРОВАНИЯTHE DYNAMICS OF THE BLOOD PRESSURE AND ITS DAILY PROFILE IN PATIENTS WITH STANDARD PROGRAM HAEMODYALISIS: THE DATA FROM 48 HOURS MONITORINGДобронравовВ. А.DobronravovV. A.

Научно-исследовательский институт нефрологии, кафедра пропедевтики внутренних болезней

197022, Санкт-Петербург, ул. Л.Толстого, 17, СПбГМУ им.акад. И.П.Павлова, Нефрокорпус. Тел.: (812)-234-51-01

dobronravov@nephrolog.ruБоровскаяЕ. А.BorovskayaE. V.

Научно-исследовательский институт нефрологии, кафедра пропедевтики внутренних болезней

ВладимироваЮ. Ф.VladimirovaU. F.

Научно-исследовательский институт нефрологии, кафедра пропедевтики внутренних болезней

СмирновА. В.SmirnovA. V.

Научно-исследовательский институт нефрологии, кафедра пропедевтики внутренних болезней

Санкт-Петербургский государствен­ный медицинский университет им. акад. И.П. ПавловаRussian Federation2009100220091324249Copyright © Добронравов В.А., Боровская Е.А., Владимирова Ю.Ф., Смирнов А.В., 20092009Добронравов В.А., Боровская Е.А., Владимирова Ю.Ф., Смирнов А.В.Dobronravov V.A., Borovskaya E.V., Vladimirova U.F., Smirnov A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/1160

ЦЕЛЬ ИССЛЕДОВАНИЯ изучение динамики артериального давления (АД) во время сеанса гемодиализа (ГД) и в междиализный период, а также суточного профиля АД в превалентной группе больных, получающих лечение хроническим ГД. ПАЦИЕНТЫ И МЕТОДЫ. Обследована превалентная группа стабильных больных на программном гемодиализе (n=70). Всем пациентам было выполнено 2-суточное амбулаторное мониторирование АД (АМАД). Анализировали динамику изменений АД в ходе процедуры ГД; средние значения и расчетные индексы систолического (САД), диастолического (ДАД), пульсового (ПАД) и среднего АД (АДср) во время сеанса ГД, в дневное и ночное время междиализного периода. РЕЗУЛЬТАТЫ. Во время процедуры ГД происходит достоверное снижение САД, ДАД и АДср. (все р<0,0001). Достоверной динамики ПАД в течение сеанса ГД не происходит (р=0,34). Закономерности динамики для САД, ДАД, АДср и ПАД в междиализный период общие: в течение 1-го дня после сеанса ГД отмечается тенденция к дальнейшему снижению АД, с минимальными значениями в 1-ю ночь; показатели АД в 1-й и 2-й последиализные дни практически одинаковы; ночные значения АД во 2-е сутки значительно увеличиваются; к окончанию 2-х суток наблюдения АД возвращается к своему исходному уровню. Между 1-ми и 2-ми сутками наблюдения отмечены достоверные различия по динамике АД ночью, которые касались САД (р= 0,004) и АДср. (р= 0,021). Различия в динамике ДАД в 1-ю и 2-ю ночь не достигали выбранного уровня достоверности (р= 0,08). Большинство пациентов (61,4%) имеют нарушенный суточный профиль АД в 1-ю ночь после процедуры ГД, с увеличением этого показателя во 2-ю ночь (79%). Уменьшение способности к ночному снижению АД во 2-ю ночь наблюдения подтверждается такими расчетными параметрами, как доля измерений АД, с превышением «гипертензионного» порога и индекс времени гипертензии для САД, различий по тем же самым индексам для ДАД не обнаружено. ЗАКЛЮЧЕНИЕ. Описаны закономерности изменения АД и его суточного профиля, что может иметь важное значение для диагностики гипертензии/гипотензии у диализных больных и коррекции терапии.

THE AIM of the investigation was to evaluate the dynamics of blood pressure (BP) during the haemodyalisis (HD) session and during the interdyalisis period, and also daily profile of BP in prevalent group of patients, who receive treatment by chronic HD. PATIENTS AND METHODS. A prevalent group of stable patients on programmed haemodyalisis was investigated (n = 70). To all patients was performed 48 hours BP ambulatory monitoring (BMAP). The dynamics of BP changes during the course of HD procedure was analyzed; the mean values and calculated indexes of systolic (SBP), diastolic (DBP), pulse (PBD) and mean BP (BPm) during HD procedure, in day and night interdyalisis period were evaluated. RESULTS. During the HD procedure a reliable decrease of SBP, DBP and BPm (all p < 0,0001) took place. The reliable dynamics of PBP during the HD procedure does not take place (p = 0,34). The stability of the dynamics for SBP, DBP, BPm and PBP in interdyalisis period are common: during the first day after the HD procedure a tendency to the decrease of the BP is noted, with the minimal values during the first night; the BP values during the 1st and 2nd days after dialysis are practically the same; the night values of BP in the 2nd day significantly increase; by the end of the 2nd day of the evaluation BP returns to its base level. Between the 1st and 2nd day of the evaluation the reliable differences in the BP dynamics at night were noted, which had to do with SBP (p = 0,0004) and BPm (p = 0,021). The differences in the dynamics of DBP in 1st and 2nd night did not reach the chosen level of reliability (p = 0,08). Most of the patients (61,4%) had disturbed daily profile in the 1st night after the HD procedure, with the increase of this values in the 2nd night (79 %). The decrease of the ability to the night BP decrease in the 2nd night of the investigation is supported by calculated parameters, as the part of BP evaluation, with the increase of the hypertension threshold and time hypertension index for SBP, the differences on the same indexes for DBP was not noted. CONCLUSION. The method of 48 hour BP monitoring allows close evaluation of the conformity dynamics and daily profile of BP, which can be significant for diagnostics of hypertension/hypotension in dialysis patients and therapy correction.

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The authors declare that there are no conflicts of interest present.