血液透析对心脏形态和功能的影响

Effect of Hemodialysis on Heart Morphous and Function

目的:了解长期血液透析患者心脏形态结构和功能情况以及血液透析对心脏形态和功能的改变,探讨可能引起血液透析患者心血管损害的相关因素。方法:随机选取成都铁路分局医院血液净化中心维持血液透析6月以上患者32例,分别于透析前2h和透析后2h用彩色多普勒超声检测左心室舒张末期内径(LVDd)、室间隔厚度(IVS)、左室后壁厚度(LVPW),同时测量射血分数(EF)、过二尖瓣口前向最大血流速度(舒张早期E、舒张晚期A),收集患者的临床资料并计算出Kt/V、左室重量指数(LVMI)和透析间期体重增加率。结果:与透析前相比,透析后左室肥厚改善不明显,但左室腔明显缩小;心脏舒张功能明显减弱,但心脏收缩功能减弱不明显。COX风险比例模型分析显示,透析前后左室直径的变化量、心脏舒张功能的变化量均与透析间期体重增加率呈正相关;透析前后心脏舒张功能的变化量与Kt/V呈负相关。直线相关分析显示,左室重量指数与透析间期体重增加率呈直线相关关系;左室重量指数与收缩压呈直线相关关系。结论:容量超负荷、收缩压是促进左室肥厚的危险因素;容量超负荷是促进左室腔扩大的危险因素;控制透析间期体重增长、充分透析,对改善心脏舒张功能具有重要意义。

Objective：To learn heart morphous and function of maintenance hemodialysis patients and effect of hemodialysis on heart morphous and function,to investigate factor of cardiovascular injure in maintenance hemodialysis patients.Methods：Measured LVDd、IVS、LVPW、EF、prorsad peak veloity of mitral orifice、Ab、HB、CRP、BP（before and after hemodialysis） and Bun of 32 maintenance hemodialysis patients（course6 month） in Chengdu railway hospital hemodialysis department with Doppler ultrasound on prehemodialysis and posthemodialysis second hours,then calculated Kt/V、LVMI and increasing rate of weight during hemodialysis.Had their age、sex、body height、weight and increasing amount of weight during hemodialysis.Results：LVDd became smaller and heart diastolic function was obviously weakened after hemodialysis than before hemodialysis,but left ventricular hypertrophy and heart systolic function were obviously different after hemodialysis than before hemodialysis.Change amount of left ventricle and cardiac diastolic function were positive correlation with increasing rate of weight during hemodialysis,but Change amount of cardiac diastolic function were negative correlation with Kt/V during hemodialysis with COX,s proportional hazard model.LVMI was positive correlation with increasing rate of weight during and SBP with liner correlation analysis.Conclusion：Volume overload and SBP are risk factor of left ventricular hypertrophy,then volume overload is also risk factor of left ventricular cavern dilation.It is significance to improve heart systolic function to control weight increasing during hemodialysis thoroughly.