血液透析患者透析前后QT间期及QT离散度变化的临床意义

Changes of QT interval and QT dispersion in maintenance hemodialysis patients

目的:探讨血液透析对患者QT间期和QT离散度(QTd)的影响。方法:对58例维持性血液透析(MHD)患者行超声心动检查并于透析前、后行心电图检查,测量计算QT间期、校正QT间期、QTd、校正QTd(QTcd)。结果:与对照组相比,MHD患者左心室心肌重量指数(LVMI)显著增加(P<0.01);两组间最大QT间期(QTmax)无明显差异,校正后MHD患者最大QT间期(QTcmax)延长(P<0.05),QTd及QTcd均较对照组有极为明显的增加(均P<0.01);透析后QTmax、QTcmax、QTd、QTcd均较透析前明显延长(均P<0.05);MHD患者透析前QTd与其LVMI、透析前平均动脉压呈正相关(r分别为0.41和0.34,P<0.05)。结论:MHD患者LVMI增加,QTcmax、QTd、QTcd延长,透析后更加显著,血液透析后发生室性心律失常的危险性增大。

Objective To discuss the effects of hemodialysis on QT interval and QT dispersion in maintenance hemodialysis patients. Methods Left ventricular thickness and mass were measured by echocardiogram in 58 maintenance hemodialysis patients. QT interval and QT dispersion were measured by 12-lead synchronously recording ECG and corrected QT internal, QTcd were calculated. Results LVMI, QTcmax, QTd and QTcd of hemodialysis patients were longer than that of normal eontrols（P 〈 0.05）; post-values of QTmax, QTcmax, QTd, QTed were longer than pre-values （P 〈 0.01）; QTd was directly correlated to LVMI and pre-dialysis MAP （r = 0.41 and 0.34 respectively, P 〈 0.05）. Conclusion The hemodialysis session may predispose some individuals to ventricular arrhythmias, and measuring QTd, QTcd may be a way to evaluate the risks of ventficular arrhythmias.