容量和压力负荷及神经体液调节对血透析患者心力衰竭的影响

Influence of blood volume load,pressure load and neurohumoral regulation on heart failure in patients with undergoing hemodialysis

目的探讨容量负荷、压力负荷及神经体液调节对血液透析(HD)患者心力衰竭的影响。方法应用血液循环动力学信息检测仪对HD患者透析前进行血流动力学参数测定,比较充血性心力衰竭(CHF)组与无充血性心力衰竭(NCHF)组左室前、后负荷及血压等的变化。结果CHF组中心静脉压(CVP)、左室舒张末期容量(LDV)、心输出量(CO)、射血阻抗(ER)、主动脉弹性模量(OM)、收缩压(SBP)显著高于NCHF组,心肌顺应性、综合反射系数(SEC)明显低于NCHF组[(37.6±13.9)cm H2Ovs(18.4±6.3)cm H2O、(378±207)mlvs(279±114)ml、(15.5±6.2)L.min-1vs(10.8±3.1)L.min-1、(207±42)g.cm-4.s-1vs(176±36)g.cm-4.s-1、(14.3±5.3)N.cm-2vs(9.6±2.3)N.cm-2、(174±27)mmHgvs(155±26)mmHg、(16.9±9.1)vs(22.9±10.2)、(1.07±0.11)vs(1.17±0.10),P均<0.01]。结论CHF患者LDV、ER、OM升高,心肌顺应性降低,微循环障碍是导致CHF的重要因素。

Objective To study the influence of blood volume load,pressure load and neurohumoral regulation on heart failure in patients with undergoing hemodialysis（HD）.Methods Hemodynamic parameters were measured for patients with undergoing HD by using circulation dynamics detection equipment.The value of left ventricular preload,after-load and blood pressure were compared between the patients with congestive heart failure（CHF）and those with non-congestive heart failure（NCHF）.Results The value of central venous pressure（CVP）,left ventricular end-diastolic volume（LDV）,cardiac output（CO）,jet resistance（JR）,aortic modulus（OM）and systolic blood pressure（SBP）were significantly higher in patients of CHF group than those in patients of NCHF group[（37.6±13.9）cm H2O vs（18.4±6.3）cm H2O,（378±207）ml vs（279±114）ml,（15.5±6.2）L·min-1 vs（10.8±3.1）L·min-1,（207±42）g·cm-4·s-1 vs（176±36）g·cm-4·s-1,（14.3±5.3）N·cm-2 vs（9.6±2.3）N·cm-2,（174±27）mm Hg vs（155±26）mm Hg,respectively,P0.01];while the evaluation value of cardiac muscle compliance and synthesis echo coefficient（SEC）were significantly lower in patients of CHF group than those in patients of NCHF group[（16.9±9.1）vs（22.9±10.2）,（1.07±0.11）vs（1.17±0.10）,P 0.01].Conclusion The CHF was associated with increase of left ventricular end-diastolic volume,jet resistance and aortic modulus,and also with decrease of cardiac muscle compliance as well as with micro-circulation disturbance.