单次血液透析对终末期肾病血液透析患者动脉功能的影响

Effect of a single hemodialysis on arterial function of patients with end-stage renal disease

目的 探讨单次血液透析对终末期肾病 (ESRD)患者动脉功能的急性效应及其影响因素。方法 采用Dynapulse 2 0 0M动脉功能测定仪检测 19例ESRD长期维持血液透析患者血液透析前、血液透析后即刻和血液透析后5小时动脉功能 ,同时于血液透析前、血液透析后即刻留取静脉血样测定血尿素氮、肌酐、血清钙、钠、钾、氯离子的浓度。结果 4小时的血液透析后 ,患者即刻的收缩压 (SBP)、舒张压 (DBP)、脉压 (PP)均较血液透析前明显下降 (P <0 .0 5 ) ,系统血管顺应性 (SVC)、肱动脉扩张性 (BAD)与血液透析前比都显著改善 (P <0 .0 5 ) ,系统血管阻力 (SVR)较前降低 (P <0 .0 5 )。血液透析结束后 5小时上述血压指标及动脉功能指标均恢复到血液透析前水平 ,与血液透析前比差异均无统计学意义 (P >0 .0 5 )。相关及多元线性回归分析显示 ,血液透析前、血液透析后即刻和血液透析后 5小时的SVC均与相应的PP呈高度负相关关系 (r >- 0 .7,P <0 .0 5 ) ,血液透析前SVC与血液透析前血钙呈负相关关系 (r =- 0 .735 ,P <0 .0 1) ,血液透析后即刻的SVC与血液透析后血钙无相关性。结论 单次血液透析对动脉功能的改善是暂时的急性效应 ,是伴随血压的变化而发生的 ,血清钙水平在血液透析前与动脉弹性功能呈负相关关系 。

Objective To investigate the acute effect of arterial function and explore the influence factor on hemodialysis patients with end-stage renal disease (ESRD).Methods Nineteen chronic hemodialysis patients with ESRD were detected pre-hemodialysis(pre-HD), post-hemodialysis(post-HD) and 5 hours post-HD by Dynapulse 200M,in the meantime,blood sample was obtained from vein,blood urea nitrogen(BUN),serum creatinine(SCr),serum calcium,serum potassium,serum natrium and serum chlorine level were measured.Results Significant decreases occurred in systolic blood pressure(SBP),diastolic blood pressure(DBP)and pulse pressure(PP),systemic vascular resistance(SVR) during routine hemodialysis(P< 0.05).Systemic vascular compliance(SVC) and brachial artery distensibility(BAD) of hemodialysis patients were significantly improved at the end of the dialysis (P< 0.05).There was no significant change on blood pressure and arterial function before and 5 hours post-HD(P> 0.05).Simple correlate and multiple regression indicated: SVC had a significant inverse relationship with PP pre-HD,post-HD and 5 hours post-HD (r> -0.7,P< 0.01).SVC post-HD also related significantly to serum calcium level pre-HD,but there was no relation between them.Conclusion Arterial function of hemodialysis patients with ESRD improves after a single dialysis,the changes are mediated mostly by parallel changes,they are reversible.SVC has an inverse relationship with pre-HD calcium level,but the relationship disappears at post-HD.