摘要
探讨透析液钙浓度变化对血液透析病人QT间期及QT间期离散度的影响。对 15例慢性肾衰长期维持性血液透析病人先后应用钙浓度为 1 2 5mmol/L(dCa2 + 1 2 5 )、1 5mmol/L(dCa2 + 1 5 )及 1 75mmol/L(dCa2 + 1 75 )的透析液各连续进行 5次血液透析 ,分别于第 5次透析时观察透析前后有关临床及实验室指标 ,测量并计算QT间期 (QT)及QT间期离散度 (QTd)。结果显示 ,采用dCa2 + 1 2 5血液透析时 ,血总钙及血清Ca2 + 明显下降 (P <0 0 5 ) ,QT明显延长、QTd明显增大 (P <0 0 5 ) ;采用dCa2 + 1 5及dCa2 + 1 75血液透析时 ,血总钙及血清Ca2 + 明显升高 (P <0 0 5 ) ,QT在dCa2 + 1 5透析时有缩短趋势 ,但差异无显著性意义 (P >0 0 5 ) ,而在dCa2 + 1 75透析时明显缩短 (P <0 0 5 ) ,QTd在dCa2 + 1 5及dCa2 + 1 75透析时虽有增大趋势 ,但差异无显著性意义 (P >0 0 5 )。提示不同钙浓度的透析液进行血液透析均引起QTd增大 ,但只有低钙血液透析时在引起QT明显延长的同时 ,QTd才明显增大 ,从而增加发生心律失常 。
To investigate the effect of calcium concentration in dialysate on the QT interval (QT) and QT interval dispersion (QTd) during hemodialysis(HD) in patients with end stage renal disease (ESRD), Ca 2+ concentrations of 1 25mmol/L (dCa 2+ 1 25), 1 5mmol/L (dCa 2+ 1 5) and 1 75mmol/L (dCa 2+ 1 75) in dialysate were given to 15 ESRD patients for five times. The QT and QTd were measured before and after the five HD sessions. The results showed: With the dCa 2+ 1 25 HD, serum Ca 2+ and plasma calcium were decreased (1 22±0 08 vs 1 17±0 07 mmol/L and 2 43±0 34 vs 2 28±0 16mmol/L, P <0 05), the QT and QTd were increased (385±46 vs 406±48ms and 51±16 vs 65±24ms, P <0 05). With the dCa 2+ 1 5 and dCa 2+ 1 75 HD, serum Ca 2+ and plasma calcium were increased( P <0 05), the QT remained stable (dCa 2+ 1 5) or was decreased (dCa 2+ 1 75), the QTd only showed a tendency to increase( P >0 05). The changes in the QT correlated inversely with the changes in serum Ca 2+ and plasma calcium ( P <0 01). It is suggested that the changes in dialysate calcium concentration affect directly the concentration of serum Ca 2+ , plasma calcium and also the QT interval. HD with different calcium concentrations in dialysate increases the QTd, but HD with a low calcium dialysate is the only procedure inducing a significant increase in the QT and QTd. The use of low calcium dialysate may predispose HD patients to ventricular arrhythmias.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2002年第3期268-270,共3页
Medical Journal of Chinese People's Liberation Army