透析液钙浓度对血液透析患者左心室结构和功能的影响  

Effect of dialysate calcium concentration on left ventricular structure andfunction of maintenance hemodialysis patients

作　　者：周伟[1] 赵学伟[1] 张智敏[1] 李大勇[1] 张华[1] 

机构地区：[1]解放军总医院第309临床部,北京100091

出　　处：《中国血液净化》2005年第9期476-478,490,共4页Chinese Journal of Blood Purification

摘　　要：目的探讨透析液钙浓度变化对血液透析患者左心室结构和功能的急性影响。方法对解放军总医院第309临床部的30例慢性肾衰竭长期维持性血液透析患者,先后应用钙浓度为1.25mmol/(LdCa2+1.25)、1.5mmol/L(dCa2+1.5)及1.75mmol/L(dCa2+1.75)的透析液各连续进行15次血液透析,分别于第15次透析时观察透析前后有关临床及实验室指标,采用彩色多普勒超声仪测量并计算左室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、射血分数(EF)、短轴缩短分数(FS)、左心室等容舒张期时间(IVRT)、舒张早期最大血流速(Emax)、舒张晚期最大血流速(Amax)及舒张早期最大血流速与舒张晚期最大血流速之比(E/Amax)。结果分别采用3种钙浓度的透析液进行血液透析,除血清钙离子及血iPTH的变化差异有显著性外(P<0.05),其它临床及实验室观察指标的变化差异均无显著性(P>0.05);未发现IVST、LVPWT、LVEDD、LVESD、EF、FS、Emax及Amax透析前后有显著性变化(P>0.05);E/Amax均趋于减小,IVRT均趋于增大,但只有dCa2+1.75血液透析时,E/Amax及IVRT的变化才有显著性(P<0.05)。相关性分析发现只有血清钙离子变化与E/Amax的变化呈负相关(r=-0.34,P<0.05),与IVRT的变化呈正相关(r=0.27,P<0.05)。结论不同钙浓度透析液进行血液透析,不影响患者的左心室结构及收缩功能;高钙透析液血液透析由于引起血清钙离子浓度明显升高,较低钙透析液血液透析容易造成左心室舒张功能的急性损害。Objective To investigate the effect of dialysate calcium concentration on the left ventricular（LV） structure and function of maintenance hemodialysis（HD） patients with end-stage renal disease（ESRD）. Methods Fifteen HD treatments were applied respectively with dialysate Ca^2＋ concentrations of 1.25mmol/L（dCa^2＋1. 25）,1. 5mmol/L（dCa^2＋1.5）and 1.75mmol/L （dCa^2＋1.75） in 30 ESRD patients. The LV structure and function were echocardiographically examined before and after the fifteenth HD session, respectively. Results Serum Ca^2＋ decreased signifi cantly during the dCa^2＋1. 25 HD（1.24±0.08 vs 1.16±0.07 mmol/L P〈0. 05）, serum Ca^2＋ increased significantly with the dCa^2＋1. 5HD（1.22±0.07 vs. 1.28±0.08 mmol/L P〈0. 05） and dCa^2＋1. 75 HD （1.23±0.08 vs 1.32±0. 09mmol/L P 〈0.05）, and plasma intact parathyroid hormone（iPTH） de creased significantly with the dCa^2＋1. 5 HD（218± 146vs. 182±156ng/L P 〈 0. 05）and dCa^2＋1. 75 HD （215±157 vs 166± 150ng/L P 〈0.05）. LV structure and systolic function were not altered during any of the treatments. The changes in E/Amax and isovolumic relaxation time IVRT suggested impairment of LV relaxation during HD in each session, but only with the dC^2＋1.75 HD was the impairment statistically significant（E/Amax 1.27 ±0.31 vs. 0.92 ±0.32 P〈0. 05; IVRT （133±27） vs （168±39）msecond, P 〈0.05）. The change in serum Ca^2＋ was the only variable correlating independently with the changes in E/Amax（r=- 0.34, P 〈0.05） and IVRT（r=0.28, P 〈0.05）. Conclusion The changes in dialysate calcium concentration affect serum Ca^2＋ directly. HD with different calcium concentration dialysate does not impair the LV structure and systolic function; HD with high calcium dialysate impairs LV diastolic function when compared with lower calcium dialysate treatmemt.

关 键 词：慢性肾衰竭 血液透析 钙 左心室 超声心动图 

分 类 号：R692.5[医药卫生—泌尿科学]