血液透析患者心率储备对血流动力学的影响

Effects of Heart Rate Reserve on Hemodynamic in Patients with Hemodialysis

目的探讨血液透析患者心率储备对血流动力学等心脏功能的影响。方法应用无创的血液循环动力学信息检测仪对血液透析患者进行血流动力学检测,分析不同心率时各种血流动力学参数的变化以及不同射血分数时心率、心输出量、心脏效率等变化。结果 1、血液透析患者心率中位数93次/分显著高于正常人群;2、随着心率逐渐增加(心率<80次/分组、(80~99)次/分组、(100~119)次/分组、≥120次/分组),有效循环血量、每搏血量、每搏功、左室顺应性、射血分数、心脏效率均逐渐下降,左室舒张末期压力逐渐升高[(4083±1140)ml V.S.(3615±1199)ml V.S.(2559±814)ml V.S.(2258±578)ml,(137±47)ml V.S.(129±54)ml V.S.(93±38)ml V.S.(88±29)ml,(13.8±5.8)V.S.(12.6±5.9)V.S.(10.1±3.8)V.S.(9.1±2.9),(30.7±14.5)V.S.(20.9±5.9)V.S.(12.5±3.8)V.S.(9.8±2.5),(0.512±0.078)V.S.(0.489±0.078)V.S.(0.471±0.061)V.S.(0.451±0.037),(29.7±9.6)V.S.(24.4±7.9)V.S.(21.4±6.2)V.S.(16.7±4.6),(9.4±3.6)mm Hg V.S.(12.9±4.7)mm Hg V.S.(16.1±5.3)mm Hg V.S.(20.6±5.8)mm Hg,P<0.05];3、随着射血分数下降(≥0.55组,0.54~0.50组,0.49~0.45组,<0.45组),心率、左室舒张末期容量增加,心脏效率降低[(84±16)次/分V.S.(89±17)次/分V.S.(99±20)次/分V.S.(102±21)次/分,(140±48)ml V.S.(181±52)ml V.S.(235±85)ml V.S.(363±155)ml,(35.9±9.5)V.S.(28.1±5.6)V.S.(22.2±4.7)V.S.(17.2±3.9),P<0.05]。结论血液透析患者心率增加、心率储备下降,心率与左室顺应性、心脏效率、心脏功能等呈负相关。

Objective: To investigate the effect of heart rate reserve on hemodynamic in patients with hemodialysis. Methods: Hemodynamic parameters were examined in patients with hemodialysis by using circulation dynamic detection. To analyze the hemodynamic parameters that changes in different heart rate, and heart rate, cardiac output, cardiac efficiency in different ejection fraction. Results: 1) The median heart rates of the patients with hemodialysis were 93 beat in a minute which were significantly higter than healthy adults. 2) With the increase of heart rate, effective circulation volume, stroke volume, stroke work, left ventricular end diastolic volume, left ventricular compliance, ejection fraction, cardia efficience were also falling; in the meanwhile, the left ventricular end diastolic pressure was rising. 3) With the decrease of ejection fraction, heart rate, left ventricular end diastolic volume were rising,and cardiac efficience was falling at the same time. Conclusion: For patients with hemodialysis the heart rate is increasing, heart rate reserve is decreasing. There is negative correlation between the heart rate and left ventricularcompliance, cardiac efficience and cardiac function.