胸阻抗监测对腹膜透析患者心功能评价的作用

Role of thoracic electrical bioimpedance monitoring in the evaluation of cardiac function in peritoneal dialysis patients

目的探讨胸阻抗监测对腹膜透析（PD）患者心功能评价的作用及临床应用价值。方法对101例住院的持续非卧床腹膜透析（CAPD）患者及30例健康人（对照组）行胸阻抗法（TEB）无创血流动力学监测与心脏彩超检查，进行两组间比较及相关性分析。结果心脏彩超检查提示CAPD患者左心房内径（LAD）、左室舒张末期内径（LVDd）、左室收缩末期内径（LVDs）、室间隔厚度（IVST）、肺动脉压力（PAP）、左心室质量指数（LVMI）显著高于对照组（均P〈0．05），舒张早期和舒张晚期二尖瓣口最大血流速度之比（E／A）低于对照组（P〈0．05）。胸阻抗监测显示CAPD患者心输出量（CO）、每搏输出量（SV）、加速指数（ACI）、射血分数（EF）、速度指数（VI）显著低于对照组（均P〈0．01），收缩时间比（STR）、系统血管阻力（SVR）、胸液水平（TFC）显著高于对照组（均P〈0．01）。相关性分析显示CAPD组左心室射血分数（LVEF）与脑钠肽（BNP）呈负相关（r=-0．467，P〈0．01），LVMI与BNP呈正相关（r=0．416，P〈0．01），射血前期（PEP）、STR及TFC与BNP呈正相关（r=0．404，P〈0．01；r=0．572，P〈0．01；r=0．471，P〈0．01），EF与BNP呈负相关（r=-0．664，P〈0．01）。胸阻抗监测与心脏彩超指标之间的相关性分析显示TFC与LAD呈正相关（r=0．279，P〈0．05）；PEP、STR与LVEF呈负相关（r=-0．389，P〈0．01；r=-0．446，P〈0．01），EF与LVEF呈正相关（r=0．451，P〈0．01）；SV与E，A呈正相关（r=0．285，P〈0．05）；SVR、TFC与LVMI呈正相关（r=0．232，P〈0．05；r=0．284，P〈0．05）。结论胸阻抗监测能评估CAPD患者心功能状态，且具有动态监测、操作简单、费用低等优点，临床上可部分代替心脏彩超进行心脏功能的评价。

Objective To evaluate the effectiveness of thoracic electrical bioimpedance（TEB） in monitoring the cardiac function of peritoneal dialysis patients. Methods One hundred and one patients with continuous ambulatory peritoneal dialysis （CAPD） and 30 healthy persons （control group） were included in the study. Thoracic electrical bioimpedance （TEB） noninvasive hemodynamic monitoring and echocardiography were taken to analyze the correlation between indexes. Results Echocardiography showed that left atrial diameter （LAD）, left Ventricular end diastolic diameter （LVDd）, left ventricular end systolic diameter （LVDs）, interventricular septal thickness （IVST）, interventricular septal thickness （PAP）, left ventricle weight index （LVMI） of CAPD group were higher than that of the control group （all P 〈 0.05）, early and late wave of mitral valve flow （E/A） of CAPD group was lower than that of control group （P 〈 0.05）. TEB monitoring showed that cardiac output （CO）, stroke volume （SV）, acceleration index （ACI）, ejection fraction （EF）,velocity index （VI） of CAPD group were significantly lower than that of control group （all P 〈 0.01）, systolic time ratio （STR）, SVR, TFC of CAPD group were significantly higher than that of control group （P 〈 0.01）. Correlation analysis show that left ventricular ejection fraction （LVEF） was negatively correlated with BNP （r = -0.467, P 〈 0.01）, LVMI was positively correlated with BNP （r = 0.416, P 〈 0.01）, PEP, STR and TFC were positively correlated with BNP （r = 0.404, P 〈 0.01; r = 0.572, P 〈 0.01; r = 0.471, P 〈 0.01）, EF was negatively correlated with BNP （r =-0.664, P 〈 0.01）. Correlation analysis between echocardiography and TEB monitoring index showed there was significant correlation between EF and LVEF （r = 0.451, P 〈 0.01）, SVR and TFC were positively correlated with LVMI （r = 0.232, P 〈 0.05; r = 0.284, P 〈 0.05）, SV was positively correlated with E/A （r = 0.285, P 〈 0.05）, pre-ejection period （PEP） and STR were negatively correlated with LVEF （r =-0.389, P 〈 0.01; r =-0.446, P 〈 0.01）, TFC was positively correlated with LAD （r= 0.279, P〈 0.05）. Conclusion TEB monitoring can accurately evaluate the cardiac function with the advantage of dynamic monitoring and simple operation. It can partly replace the echocardiography test.