血液透析频率对终末期肾病患者心率变异性的影响

Impact of hemodialysis frequency on heart rate variability in patients with end stage of renal disease

目的探讨终末期肾病患者不同血液透析频率对心率变异性(HRV)的影响及血液透析前后心率变异性的变化。方法收集规律透析患者107例,根据透析频率将患者分为1次/2d(Q2d组,共40例)、1次/3d(Q3d组,共37例)及1次/4d(Q4d组,共30例),3组患者透析前后各HRV指标并进行对比分析。结果 3组患者透析后各HRV指标均出现升高,以Q2d组及Q3d组升高明显[Q2d:相邻RR间期相差>50ms的个数占总心跳次数的百分比(PNN50)7.01±3.21比6.19±2.56P<0.05,24h,全部正常RR间期的标准差(SDNN)135.11±21.98比105.29±20.78P<0.01,相邻RR间期差值均方的平方根(RMSSD)80.78±17.96比67.66±16.87P<0.01,24h内每5min的RR间期平均值的标准差119.22±23.41比108.32±21.20P<0.05,全部相邻RR间期之差的标准差(SDSD)77.38±17.78比68.29±18.48P<0.05];Q3d:SDNN128.65±23.79比101.32±19.88P<0.01,RMSSD74.69±16.56比65.36±15.19P<0.05,SDANN116.33±21.01比105.54±21.07P<0.05,SDSD73.19±17.33比65.17±16.08P<0.05;Q4d:SDNN107.16±20.04比90.86±19.54P<0.05,RMSSD66.74±17.82比58.63±15.88P<0.05),透析前、后3组患者间的方差分析结果显示组间的差别有统计学意义(透析前:PNN50、SDNN、RMSSD、SDANN、SDSD的F值分别为2.96、3.65、3.09、3.34、2.90,P<0.05;透析后:PNN50、SDNN、RMSSD、SDANN、SDSD的F值分别为2.96、3.65、3.09、3.34、2.90,P<0.05),且随着透析次数减少HRV有降低趋势。结论长期充分的血液透析可能有助于心脏自主神经功能的改善。

Aims To explore the impact of hemodialysis and hemodialysis frequency on heart rate variability (HRV) in patients with end stage renal disease. Methods A total of 107 patients treated with regular hemodialysis were enrolled in this study. They were assigned into 3 groups according to the hemodialysis frequency: Q2d group (once every 2 days), Q3d group (once every 3 days) and Q4d group (once every 4 days). The parameters of HRV were compared between the 3 groups. Results The parameters of HRV were increase after hemodialysis in all patients, especially higher in Q2d and Q3d group (Q2d:PNN50 7.01±3.21 vs 6.19±2.56 P<0.05,SDNN 135.11±21.98 vs 105.29±20.78 P<0.01, RMSSD 80.78±17.96 vs 67.66±16.87 P<0.01,SDANN 119.22±23.41 vs 108.32±21.20 P<0.05,SDSD 77.38±17.78 vs 68.29±18.48 P<0.05;Q3d:SDNN 128.65±23.79 vs 101.32±19.88 P<0.01,RMSSD 74.69±16.56 vs 65.36±15.19 P<0.05,SDANN 116.33±21.01 vs 105.54±21.07 P<0.05,SDSD 73.19±17.33 vs 65.17±16.08 P<0.05;Q4d:SDNN 107.16±20.04 vs 90.86±19.54 P<0.05, RMSSD 66.74±17.82 vs 58.63±15.88 P<0.05). A means of analysis of variance model showed that there is a significant deference between the 3 groups in before and after hemodialysis (Before:F value of PNN50, SDNN, RMSSD, SDANN and SDSD were 2.96, 3.65, 3.09, 3.34 and 2.90,P<0.05;After:F value of PNN50, SDNN, RMSSD, SDANN and SDSD were 2.96, 3.65, 3.09, 3.34 and 2.90,P<0.05). HRV has been trending down with the reduce of hemodialysis. Conclusions Long term and adequate hemodialysis may be useful for the improvement of heart autonomic function.