维持性血液透析患者脑血流动力学分析

Cerebral vascular hemodynamic analysis of maintenance hemodialysis patients

目的 探讨血液透析对尿毒症维持性血液透析患者脑动脉血流动力学的影响。方法 采用经颅多谱勒超声 ,分别于血液透析前、血液透析中 (血液透析开始后 2h)及血液透析结束后 2h测量患者脑动脉收缩期血流速度 (Vp) ,平均血流速度 (Vm)及脑动脉搏动指数 (PI) ;对比分析血液透析对维持血液透析患者脑血流动力学影响。结果 血液透析中Vp、Vm显著增快 ,与血液透析前、血液透析后比较有显著性差异 (P <0 .0 0 1) ,血液透析后Vp、Vm较血液透析前在短期内下降 (P <0 .0 1) ,大脑中、前动脉搏动指数低于正常值 ,但血液透析前、中、后组间比较无显著性差异 (P >0 .0 1) ,其余均在正常值内 ,组间无显著差异(P >0 .0 1)。结论 维持性血液透析患者血液透析过程中有脑动脉血流动力学显著异常 ;血液透析后较血液透析前在短期内进一步下降。血液透析对脑动脉的顺应性和弹性无明显影响。这可能就是维持性血液透析患者脑血管意外高发的原因之一。

Objective To investigate the effect of on cerebralvascular hemodynamics hemodialysis in patients with maintenance hemodialysis.Methods By transcranial doppler ultrasound, the patients' cerebral artery systolic peak flow velocity(VP) and mean flow velocity(Vm) and pulsate index of cerebral artery (PI) were measured before hemodialysis,during hemodialysis (2hs after a hemodialysis session begin) and 2hs after a hemodialysis session over. Results Vp、Vm increased during hemodialysis, P<0.001, and decreased. After hemodialysis in a short period significantly. The pulsate index of middle cerebral artery and anterior artery were lower than normal,but there were no significant difference (P>0.01), the other parameters were normal and have no obvious variety among groups the three. Conclusion Cerebral hemodynamics have obvious changes during hemodialysis compared with pre-hemodialysis, after hemodialysis there were no obvious effects on compliance and elasticity of cerebral artery. These may be one of the reason why hemodialysis patients had a high cerebralvascular stroke incidence.