透析液钙浓度对血液透析患者QT间期及心律失常的影响

Effects of dialysate calcium concentration on QT interval and arrhythmia during hemodialysis

目的 探讨透析液钙浓度变化对血液透析 (HD)患者QT间期 (QT)、QT间期离散度(QTd)及心律失常的影响。方法 对 15例慢性肾功能衰竭长期维持性血液透析患者先后应用钙浓度为 1.2 5mmol/L(dCa2 + 1.2 5 )、1.5mmol/L(dCa2 + 1.5 )及 1.75mmol/L(dCa2 + 1.75 )的透析液各连续进行 5次血液透析 ,分别于第 5次透析时观察透析前后有关临床及实验室指标 ,测量并计算QT间期 (QT)及QT间期离散度 (QTd) ,计算透析期间平均每小时室性异位心搏数 (VE)和室上性异位心搏数 (SVE)。结果 采用dCa2 + 1.2 5血液透析时血清Ca2 + 明显下降 (P <0 .0 5 ) ,QT明显延长 ,QTd明显增大 (P <0 .0 5 ) ;采用dCa2 + 1.5及dCa2 + 1.75血液透析时血清Ca2 + 明显升高 (P <0 .0 5 ) ,QT在dCa2 + 1.5透析时有缩短趋势 (P >0 .0 5 ) ,而在dCa2 + 1.75透析时明显缩短 (P <0 .0 5 ) ,QTd在dCa2 + 1.5及dCa2 + 1.75透析时仅有增大趋势 (P >0 .0 5 ) ;3种钙浓度透析液血液透析期间SVE发生率无显著性差异 (P >0 .0 5 ) ,但dCa2 + 1.2 5血液透析时VE发生率较dCa2 + 1.5及dCa2 + 1.75血液透析时明显增加 (P <0 .0 5 )。结论 不同钙浓度透析液血液透析均引起QTd增大 ,但只有低钙血液透析时在引起QT明显延长的同时 ,QTd才显著增大 ,室性异位心搏?

Objective To investigate the effect of dialysate calcium concentration on the QT interval (QT),QT interval dispersion(QTd) and arrhythmia during hemodialysis(HD) in patients with end-stage renal disease(ESRD).Methods Five HD treatments were respectively applied with dialysate Ca 2+concentrations of 1.25?mmol/L (dCa 2+1.25),1.5?mmol/L(dCa 2+1.5) and 1.75?mmol/L(dCa 2+1.75) in 15 ESRD patients. The QT and QTd were measured before and after the fifth HD session. The ventricular ecotype (VE) and supraventricular ecotype (SVE) were recorded during the fifth HD session. Results With the dCa 2+1.25 HD,serum Ca 2+decreased(P<0.05),the QT and QTd increased(P<0.05). With the dCa 2+1.5 and dCa 2+1.75 HD, serum Ca 2+increased (P< 0.05), the QT remained stable (dCa 2+1.5) or decreased (dCa 2+1.75), the QTd only showed a tendency to increase (P> 0.05).The incidences of SVE were comparable among the three different HD treatments, but the incidence of VE during dCa 2+1.25 HD was significantly higher than that during dCa 2+1.5 and dCa 2+1.75 HD (P< 0.05). The changes in the QT correlated inversely with the changes in serum Ca 2+(P< 0.001).Conclusion The QTd trends to increase during HD with different calcium concentration dialysate,but HD with the low-calcium dialysate is the only procedure that induced a significant increase in the QT and QTd. The use of low-calcium dialysate may predispose HD patients to ventricular arrhythmia.