血透对慢性肾功能衰竭患者心脏结构和功能的影响

Effects of Hemodialysis on Cardiac Structure and Function in Patients with Chronic Renal Failure

目的 探讨慢性肾功能衰竭 (CRF)患者心脏结构和功能的改变及血液透析对心脏的影响。方法 40例正常对照及 2 0例慢性肾衰患者血透前后分别用彩色多普勒超声心动图 (UCG)进行心脏结构和功能的测定 ,并监测透析前后血压、肾功能的变化。结果 CRF患者与正常对照组相比 ,SBP显著升高 (P <0 0 1) ,AOE降低 ,LAD、RAA、IVST、LVPWT及LVMI均明显增高 (P <0 0 1) ,心脏收缩功能代偿性增强 ,舒张功能减退。血透治疗后 ,SBP降低 ,AOE升高 ,各房室内径减小 ,LVMI及CO降低 ,左室舒张功能无明显改善。BUN降低 (48 7± 15 9)mmol/l,CRE降低 (6 5 4± 2 5 5 )mmol/l(P均 <0 0 0 1)。血压、左室舒张功能与肾功能密切相关 ,左室肥厚 (LVH)与收缩、舒张功能正相关 ,与左室内径负相关。结论 CRF患者常伴有高血压、LVH和左室舒张功能异常。血透治疗可降低LVMI,但左室舒张功能无明显改善。

Objective Toexplorethechangesofcardiacstructureandfunctioninpatientswithchronicrenalfailure (CRF)andtheeffectsofhemodialysisonheart.Methods Cardiacstructureandfunctionin 2 0patientswithCRFwereas sessedbyechocardiogrambeforeandafterhemodialysis.Fortynormalsubjectswereusedascontrolgroup .Thechangesof bloodpressureandbiochemicalparameterswereinvestigated .Results Comparedwithcontrolgroup ,SBPwasincreased significantly (P <0 0 1) .AOEwasdecreasedandLAD ,PAA ,IVST ,LVPWTwereincreasedstrongly (P <0 0 1) .Mean whilethecompetitiveincreaseofcardiacsystolicfunctionandthedecreaseofdiastolicfunctionwerefound .Afterhemodialy sis ,SBPwaslowerandAOEwashigherthanbefore,thediameterofatrialsandventricles,LVMIandcardiacoutputwere reducedrespectively ,butcardiacdiastolicfunctionwasnotimproved .BUNwasdeceased (48 7± 15 9)mmol/landCRE wasdecreased (6 5 4± 2 5 5 )mmol/l(P <0 0 0 1) .Bloodpressureandleftventriculardiastolicfunctionwereintimatelycor relatedwithrenalfunction .Leftventricularhypertrophy (LVH)waspositivelyrelatedtocardiacsystolicanddiastolicfunc tionandnegativelyrelatedtoleftventriculardiameter.Conclusion PatientswithCRFwereusualcomplicatedbyhyper tension ,LVHandabnormalcardiacdiastolicfunction .HemodialysiswoulddecreaseLVMI ,butdiastolicfunctionwouldnot beimprovedstronglybyHemodialysistherapy . [