高通量血液透析联合左卡尼汀对尿毒症心肌病的临床研究

Clinical study of high - flux hemodialysis combined with L - camitine uremic cardiomyopathy

目的高通量血液透析联合左卡尼汀对尿毒症心肌病的影响。方法选取81例于本院门诊和住院部透析的患者，随机分成两组：实验组41例，对照组40例，所有患者均每周3次血液透析，每次4h，实验组自2012年10月开始接受高通量血液透析联合左卡尼汀治疗，对照组进行单纯的高通量血液透析治疗，两组患者都观察8个月。治疗前后检测血红蛋白、血细胞比容，做常规超声心动图，观察左心室舒张期末内径（LVIDd）、左心室收缩末期内径（LVIDs）、室间隔舒张期末期厚度（IVSd）、左室心肌质量（LVM）、左室心肌质量指数（LVMI）、左室后壁厚度（PWTH）、射血分数（EF）、左心室的舒张功能（EPSS）等。结果治疗8个月后，实验组患者的血红蛋白、血细胞比容与对照组比较明显升高（P〈0．05），超声心动图EF值明显升高，LVIDd、LVIDs、IVSd、PWTH、LVM、LVMI明显降低，差异均有统计学意义（P〈0．05）。结论高通量血液透析联合左卡尼汀在改善尿毒症心肌病患者心肌重构及心功能方面有较好的疗效。

Objectives High -flux hemodialysis combined with L- carnitine on uremic cardiomyopathy. Methods 81 cases in our hospital outpatient and inpatient dialysis patients were randomly divided into two groups ：41 patients in the control group of 40 patients, all patients were dialysis three times a week ,four hours each experimental group since 2012 10 month of receiving high -flux hemodialysis combined with L - carnitine treatment, the control group simply high flux hemodialysis treatment, both groups were observed for 8 months. Before and after treatment hemoglobin, hematocrit, routine echocardiography, left ventricular end -diastolic observe the inner diameter（LVIDd） ,left ven- tricular end systolic diameter （LVIDs）, end -diastolic interventricular septum thickness of （IVSd）, left ventricular mass （LVM） , left ventricular mass index （LVMI） , left ventricular wall thickness （ PWTH）, ejection fraction （EF） ,left ventricular diastolic function （EPSS） and the like. Results After 8 months of treatment, patients in the experimental group of hemoglobin, hematocrit and the control group was significantly higher（ P 〈 0.05 ） , echocardiography EF was significantly increased left ventricular end - diastolic inner diameter （ LVIDd）, left ventricular systolic diameter （ LVIDs）, end - diastolic interventricular septum thickness of（ IVSd）, left ventricular wall thickness （PWTH）, left ventricular mass （ LVM）, left ventricular mass index （LVMI） was significantly reduced. Conclusions The high - flux hemodialysis combined with L - carnitine has a good effect in improving uremic cardiomyopathy cardiac remodeling and heart function.