血液透析时应用螺内酯对患者心功能、透析充分性及并发症的影响

Effect of spironolactone on cardiac function,dialysis adequacy and complications in hemodialysis

目的探讨螺内酯在维持性血液透析中的应用对患者心功能、透析充分性及并发症的影响。方法选取2015年9月至2016年9月该院收治的在院血液净化中心进行维持性透析患者80例作为研究对象,按双盲原则采用随机数字表法分为观察组和对照组,每组40例。观察组在常规透析基础上给予螺内酯,对照组给予安慰剂(面粉颗粒)。对比两组患者心功能、透析充分性及并发症发生情况。结果观察组患者干预后左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)均明显低于干预前及对照组干预后,左心室射血分数(LVEF)明显高于干预前及对照组干预后,差异均有统计学意义(P<0.05);对照组干预后尿素下降率(URR)、尿素清除指数(Kt/V)值与干预前比较,差异均无统计学意义(P>0.05);观察组患者干预后URR、Kt/V均明显高于干预前,差异均有统计学意义(P<0.05);观察组患者透析中低血压、高血压、心功能衰竭发生率均明显低于对照组,差异均有统计学意义(P<0.05)。结论螺内酯有助于改善血液透析患者心功能,改善透析充分性,降低并发症发生率。

Objective To investigate the effect of spironolactone on the cardiac function,dialysis adequacy and complications in maintenance hemodialysis. Methods Eighty cases of maintenance hemodialysis in the blood purification center of this hospital from September 2015 to September 2016 were selected as the study subjects and divided into the observation group and control group according to the random number table method by the double blindness principle,40 cases in each group. The observation group was given spironolactone on the basis of routine dialysis,while the control group took the placebo. Then the cardiac function,dialysis adequacy and complications occurrence were compared between the two groups. Results The left ventricular end-diastolic dimension（LVEDD） and left ventricular end systolic dimension（LVESD） after intervention in the observation group were significantly lower than those before intervention and after intervention in the control group,the left ventricular ejection fraction（LVEF） in the observation group was significantly higher than that before intervention and after intervention in the control group,the differences were statistically significant（P〈0.05）;URR and Kt/V value in the control group had no statistical difference before and after intervention（P〈0.05）;URR and Kt/V value after intervention in the observation group were significantly higher than those before intervention,the difference was statistically significant（P〈0.05）;the occurrence rates of hypotension,hypertension and cardiac function failure during dialysis in the observation group were significantly lower than those in the control group,the difference was statistically significant（P〈0.05）. Conclusion Spironolactone conduces to improve cardiac function and dialysis adequacy in the patients with hemodialysis,and reduces the occurrence rate of complications.