置管透析所致上腔静脉阻塞开通后患者右心功能变化

Effect of dialysis on the right ventricular function after treatment of superior vena cava obstruction

目的探究置管透析所致上腔静脉阻塞开通后患者右心大小和功能的变化。方法选择2015年6月~2017年5月于平煤神马医疗集团总医院应用中心静脉置管行血液透析治疗的患者56例作为研究对象,其中男性34例,女性22例,平均年龄(47.23±8.19)岁。超声心动图检测右室上下径、左右径、基底径,右室流出道(RVOT)近端、远端内径,右室壁厚度以及右室舒张末期容积(RVEDV),右室收缩末期容积(RVESV);三尖瓣环收缩期位移(TAPSE)、右室面积变化率(FAC)、右室射血分数(RVEF)、心肌做功指数(Tei)以及游离壁三尖瓣环收缩期纵向收缩最大速度(S’);下腔静脉塌陷率、三尖瓣舒张早期血流峰值速度/舒张末期血流峰值速度(E/A)、三尖瓣舒张早期E波峰值流速/多普勒e波峰值流速(E/e’)以及右房长径、右房短径、右房面积变化率。结果上腔静脉阻塞开通后,置管透析患者的右室上下径、左右径、基底径,RVOT近端、远端内径,右室壁厚度以及RVEDV、RVESV均明显低于开通前,差异有统计学意义(P均<0.05)。开通后,患者的TAPSE、FAC、RVEF以及S’水平较开通前均有所提升,Tei指数有所下降,差异有统计学意义(P均<0.05)。上腔静脉阻塞开通后,与开通前比较患者的下腔静脉塌陷率、E/A比值以及右房面积变化率明显提升,E/e’比值以及右房长径、短径均明显下降,差异有统计学意义(P均<0.05)。结论上腔静脉阻塞开通后,置管透析患者的右心收缩和舒张功能显著提升,右室大小、厚度以及体积等也显著改善。

Objective To explore the changes in the size and function of right ventricle in patients with superior vena cava obstruction caused by dialysis. Method 56 hemodialysis patients with superior vena cava obstruction undergoing central venous catheterization were enrolled. The right ventricular vertical diameter, right ventricular transverse diameter, basal diameter of right ventricular, right ventricular outflow tract （RVOT） proximal diameter, right ventricular outflow tract （RVOT） distal diameter, right ventricular wall thickness, right ventricular end-diastolic volume （RVEDV）, right ventricular end-systolic volume （RVESV）, tricuspid annular plane systolic excursion （TAPSE）, right ventricular fraction area change （FAC）, right ventricular ejection fraction （RVEF）, Tei index, peak systolic velocity （S＇） at the lateral tricuspid annulus, inferior vena cava collapse rate, E/A ratio, E/E＇ ratio, right atrium length, right atrium width, right atrium FAC were measured. Result After opening of superior vena cava obstruction, the right ventricular vertical diameter, right ventricular transverse diameter, basal diameter of right ventricular, RVOT proximal and distal internal diameter, right ventricular wall thickness and RVEDV and RVESV were significantly lower than those before opening （P〈0.05）. The levels of TAPSE, FAC, RVEF and S＇ in patients were significantly improved, and the Tei index was decreased significantly. At the same time, the inferior vena cava collapse rate and the ratio of E/A and right atrium FAC were improved significantly. E/e and the ratio of right atrial length and width were significantly decreased. There were significant differences in these above indexes before and after opening （P〈0.05）. Conclusion After opening of superior vena cava obstruction, the right ventricular function was significantly improved in hemodialysis patients with central venous catheterization. The echocardiographic findings showed that the right ventricular size, wall thickness, and right ventricular systolic function and diastolic function are significantly improved.