超声心动图评价慢性肾功能衰竭患者血液透析前后右心室功能

Assessment of right ventricular function in patients with chronic renal failure before and after hemodialysis by echocardiography

目的应用超声心动图评价慢性肾功能衰竭患者血液透析前后右心室容量和心肌力学参数变化情况。方法选取经临床确诊为慢性肾功能衰竭并行血液透析的患者100例,于血液透析前后行超声心动图检测三尖瓣侧壁瓣环收缩期位移(TAPSE)、右心室面积变化分数(RV FAC)及收缩期二维右心室游离壁峰值应变(2D RVFWLS);组织多普勒测量舒张期三尖瓣环运动速度(e、a)和收缩期三尖瓣反流峰值速度(TRmax)。比较透析前后上述各参数的变化情况;分析上述参数与透析超滤量的相关性。结果血液透析后患者体质量较透析前明显减低,差异有统计学意义(P<0.05);透析后肱动脉收缩压和舒张压与透析前比较差异均无统计学意义。透析后TAPSE为(21.36±2.35)mm,较透析前(20.23±2.30)mm增加,差异有统计学意义(P<0.05);透析前后RV FAC、2D RVFWLS、e/a及TRmax比较,差异均无统计学意义。透析后仅肱动脉舒张压与透析超滤量具有相关性(r=0.304,P=0.002)。结论 TAPSE与右心室容量负荷(前负荷)改变有关,提示血液透析可增强右心室游离壁纵向收缩功能,但与血液透析超滤量无关;透析超滤量影响肱动脉舒张压。

Objective To evaluate the changes of right ventricular volume and myocardial mechanical parameters before and after hemodialysis in patients with chronic renal failure by echocardiography.Methods One hundred patients with clinically diagnosed chronic renal failure underwent hemodialysis were enrolled in this study.Echocardiography were performed before and after hemodialysis immediately,the tricuspid annular plane systolic excursion（TAPSE）,right ventricular fractional area change（RV FAC）and the longitudinal two-dimensional right ventricular free wall systolic peak strain（2 D RVFWLS）were measured,diastolic velocity（e,a） of tricuspid annulus at free wall and systolic peak velocity of tricuspid regurgitation（TRmax） were measured by tissue Deppler imaging.The changes of the above parameters before and after hemodialysis were compared,and the correlation between above parameters and hemodialysis ultrafiltration volume was analyzed.Results The weight of patients was significantly reduced after hemodialysis（P〈0. 05）. There were no statistically significant difference of systolic and diastolic blood pressures of brachial artery before and after hemodialysis.There was a significant increment of TAPSE after hemodialysis compared with that before hemodialysis[（21.36±2.35）mm vs.（20.23±2.30）mm,P0.05].There were no statistically significant changes in RV FAC,2 D RVFWLS,e/a and TRmax before and after hemodialysis.The brachial artery diastolic blood pressure after hemodialysis was statistically correlated with ultrafiltration volume（r=0.304,P=0.002）.Conclusion TAPSE is correlated with the changes of right ventricular volume load（pre-load）,suggesting that hemodialysis could enhance the longitudinal systolic function of right ventricular free wall,but is not correlated with the volume of hemodialysis ultrafiltration.The ultrafiltration volume might impact on the brachial artery diastolic blood pressure.