血液透析对终末期肾脏病患者心脏结构与功能的影响

Analysis of Dialysis Patients with Kidney Disease on Cardiac Structure and Function of End- Stage

目的采用超声心动图检查观察血液透析对终末期肾脏病患者心脏结构和功能的影响,并探讨其相关影响因素。方法选取2013年1月～2015年2月在我院治疗的ESRD患者40例,于首次血液透析前、透析后3个月、透析后6个月分别行超声心动图检查,比较透析前后心脏结构及功能的改变。同时收集所有患者的资料、生化检查指标等进行多元线性回归分析。结果 1血透后6个月患者的SBP、BUN、Scr显著低于首次血透前（P〈0.01）,P3＋低于首次血透前（P〈0.05）;而Hb显著高于首次血透前（P〈0.01）,Alb、Ca2＋高于首次血透前（P〈0.05）;2透析后3个月及6个月患者的LAD、LVDd、IVST、LVPWT均小于首次血透前（P〈0.05）,其他指标差异无统计学意义（P〉0.05）;透析后3个月与透析后6个月心脏超声检查各指标比较差异均无统计学意义（P〉0.05）;3相关分析：首次血透前SBP与LAD、IVST呈正相关（P〈0.05）,Hb与LAD、LVDd、IVST呈负相关（P〈0.05）,Alb与LAD、LVDd呈负相关（P〈0.05）。结论血液透析可通过清除ESRD患者体内的毒素,纠正水、电解质平衡紊乱,改善贫血、营养不良等,从而减轻心脏病变,提示充分血液透析联合积极合理的对症治疗可以减少和延缓患者心血管事件的发生、发展。

Objective To observe the influence of hemodialysis on cardiac structure and function of end- stage kidney disease patients with echocardiography,and discuss the related factors. Methods Select 40 patients with end- stage renal disease who accepted treatment from January 2013 to February 2015 in our hospital. 40 patients with end- stage renal disease,who accepted treatment in our hospital from January 2013 to February 2015,are selected to have echocardiography respectively before the first hemodialysis,dialysis after 3 months and 6 months. The changes of cardiac structure and function before and after hemodialysis were compared. All the basic information and biochemical indicators of the patients were collected at the same time. The parameters relating to heart change were then analyzed by Multiple linear regression analysis. Results 1 The level of systolic blood pressure,blood urea nitrogen,serum creatinine in patients who underwent dialysis 6months later were significantly lower than pre- hemodialysis（ P 〈0. 01）,phosphorus was lower than pre- hemodialysis（ P 〈0. 05）; However,the level of hemoglobin were significantly higher than pre- hemodialysis（ P 〈0. 01）,blood albumin,blood calcium were higher than pre- hemodialysis（ P 〈0. 05）; 2 The left atrium diameter,left ventricular end diastolic diameter,interventricular septal thickness,left ventricular posterior wall thickness of patients who underwent dialysis 3 months and 6 months later were less than pre- hemodialysis（ P 〈0. 05）. Other indicators were not statistically significant（ P 〈0. 05）; The indexs of cardiac ultrasound compared were not statistically significant in 3 months later and 6 months later（ P 〈0. 05）; 3 Correlation analysis： Systolic blood pressure and left atrium diameter,interventricular septal thickness was positively correlated（ P 〈0. 05）; The hemoglobin and left atrium diameter,left ventricular end diastolic diameter,interventricular septal thickness was negatively correlated（ P 〈0. 05）; The blood albumin and left atrium diameter,left ventricular end diastolic diameter was negatively correlated（ P 〈0. 05）. Conclusion Hemodialysis can eliminate the toxin,correct water and electrolyte balance disorder,improve anemia and malnutrition in patients with ESRD,and consequently reduce their heart disease. Our studies suggest that complete hemodialysis combine with effective intervention can reduce and delay the onset and the development of cardiovascular events.