维持性血液透析期间心律失常的临床分析

The clinic analysis of arrhythmia cordis in continous hemodialysis

目的 探讨维持性血液透析期间心律失常的临床特点。方法 采用费森尤斯 40 0 8B血透机及F6透析器 ,碳酸氢盐透析液 (一般含钾量为 2 .0～ 3 .0mmol/L) ,常规肝素化抗凝 ,血流量 2 0 0～ 2 5 0ml/min ,每周透析 2～ 3次 ,每次 4～ 5h。结果 血透 10 82次 ,出现心律失常 43例次 ,发生率 4.0 % ,发生时间以上机后 2～ 4h最多为 18例次 (4 1.9% )。 43例次心律失常中 2 7例次超滤脱水量大于 2 .0kg(62 .8% )。室性早搏 12例次 ,房性早搏 10例次 ,缓慢性心律失常 15例次 ,快速性心律失常 12例次。有伴随症状者 3 1例次。血压明显下降者 2 5例次 (5 8.1% ) ,血钾偏低 5例次 ,心电图提示心肌缺血加重者2 0例次。结论 心律失常类型多种多样 ,其发生率与超滤脱水量成正比 ,低血压是其主要诱因 ,血钾异常、过敏或致热原反应也可引起心律失常发生。

Objective The clinic character of arrhythmia cordis in continous hemodialysis was studied.Methods Fesenus 4008B machine of hemodialysis ,F6 hemodialyzer, bicarbonate hemodialysis solution (the concentration of kalium was 2.0～3.0 mmol/L) were used in conventional heparin method,with blood flow being 200～250 ml/min,hemodialysis 2～3 times each week and 4～5 hours each time.Results Of 1082 cases of hemodialysis,arrhythmia cordis happened in 43 cases,the frequency was 4.0%,in 18 cases arrhythmia cordis happened in 2～4 hours after the beginning of hemodialysis(41.9%). In 43 arrhythmia cordis cases,the ultrafiltrate dehydration in 27 cases overtook 2.0 kg(62.8%).Of these cases,there were 12 of premature ventricular beats, 10 of atrial premature beats,15 of bradyarhythmia,12 of tachydysrhythmia,31 cases which had following symptoms,25 cases whose blood pressure dropped obviously,5 cases whose serum kalium was less than normal level,and 20 cases whose electrocardigram showed myocardial ischemia or the initial myocardial ischemia was more serious.Conclusion The types of arrhythmia cordis was various and the happening rate of arrhythmia cordis was proportional to the ultrafiltrate dehydration. Minimum pressure was the major cause. The abnormal serum kalium, allergic or pyrogenetic reaction could also cause arrhythmia cordis. Dystrophy and anaemia should be correctted.