Abstract:

Objective To investigate the difference of systolic blood pressure between ankle and upper arm and its influencing factors in hemodialysis patients，and provide references for the evaluation of hemodialysis patients. Methods A total of 231 maintenance hemodialysis patients were selected by convenient sampling method from June to November 2023 in the blood purification center of a tertiary A general hospital in Wuhan，Hubei Province. The patients’ medical records and the general situation were consulted through the hospital electronic medical record system，including gender，age，hemodialysis age，vascular access type，disease history，laboratory indicators and imaging data. The height，weight，water retention，upper arm blood pressure and ankle blood pressure were measured by 2 trained nurses using measuring tools validated by international standards. Multiple linear regression was used to analyze the difference between ankle and upper arm systolic blood pressure and its influencing factors. Results A total of 204 hemodialysis patients completed the investigation. The difference of ankle-arm systolic blood pressure （ankle blood pressure-arm blood pressure） in hemodialysis patients was（19.97±13.43） mmHg（1 mmHg=0.133 kPa）. The results of multiple linear regression analysis showed that gender，water retention，history of cardiovascular disease and history of cerebral infarction were the influencing factors of ankle-arm systolic blood pressure difference in hemodialysis patients，which could predict 28.70% variation. Conclusion In clinical nursing practice，the measurement of ankle-arm blood pressure should be included in the regular examination of hemodialysis patients. Nurses should strengthen health education for patients with high ankle-arm systolic blood pressure difference and guide patients to control water intake during the dialysis period. The condition of patients with low ankle-arm systolic blood pressure difference should be evaluated；the high-risk factors leading to cardiovascular and cerebrovascular diseases should be screened；patients should be guided to improve relevant examinations，and intervenes should be conducted early to reduce the occurrence of cardiovascular events and cerebral infarction.

Key words: Hemodialysis, Blood Pressure, Root Cause Analysis, Nursing Care

摘要：

目的 探讨血液透析患者踝部与上臂收缩压差值及影响因素，为血液透析患者病情评估提供参考。 方法 采用便利抽样法，选取2023年6月—11月在湖北省武汉市某三级甲等综合医院血液净化中心进行治疗的231例血液透析患者作为调查对象。通过医院电子病历系统收集患者的一般资料，包括性别、年龄、透析龄、血管通路类型、疾病史、实验室指标以及影像学资料。由2名经过统一培训的护士采用经国际标准验证合格的测量工具为患者测量身高、体重、水潴留量、上臂血压及踝部血压。采用多元线性回归分析踝部与上臂收缩压之间差值的影响因素。 结果 共204例血液透析患者完成调查。血液透析患者踝臂收缩压差值（踝部血压-上臂血压）为（19.97±13.43） mmHg（1 mmHg=0.133 kPa）。多元线性回归分析结果显示，性别、水潴留量、心血管疾病史以及脑梗病史是血液透析患者踝臂收缩压差值的影响因素，可预测其28.70%的变异。 结论 临床护理实践中应考虑将测量踝臂血压纳入血液透析患者的定期检查项目。护士应加强对踝臂收缩压差值较高患者的健康宣教，指导患者控制透析间期水分摄入；落实踝臂收缩压差值较低患者的病情评估，筛查导致心脑血管疾病的高风险因素，指导患者完善相关检查，早期干预以减少心血管事件及脑梗的发生。

关键词: 血液透析, 血压, 影响因素分析, 护理