低钙透析液对老年血透患者QTc离散度的影响  

The Effect of Low-Calcium Dialysate on Elderly Hemodialysis Patients' QTc Dispersion

作　　者：袁东[1] 滕舰[1] 孙芳[1] 

机构地区：[1]山东省烟台市烟台山医院,烟台264001

出　　处：《透析与人工器官》2008年第3期8-10,共3页Chinese Journal of Dialysis and Artificial Organs

摘　　要：目的血透患者心血管疾病的发生率增加,血透过程中室性心律失常的危险性呈增高趋势。冠状动脉疾病、心脏收缩功能不全、血透过程中血钾浓度的变化及血钙水平的异常等被认为是造成心律失常的原因,但其确切机制尚不清楚[1]。心电图(EKG)QT离散度反映心室复极时间和心肌去极化的不同步性,QT离散度增加容易引起室性心律失常和心源性猝死[2]。近年来,低钙透析液较广泛地应用于治疗血透患者的继发性甲旁亢。为探讨不同钙浓度透析液对血透患者心脏电生理稳定性的影响,本文观察了不同钙离子浓度透析时患者EKG的QT间期及QT离散度变化。方法18例尿毒症维持性血透患者,男9例,女9例,年龄(58.65±11.34)岁。因继发性甲旁亢、高磷血症,采用低钙透析液透析,2～3次/周,所有患者均无冠状动脉疾患史。所有患者均用两种钙离子浓度透析液(1.25mmol/l,1.5mmol/l)透析,作自身对照研究,于透析前后分别作EKG,并常规测定血生化(血钙、磷、氯、钠、钾、HCO3-)水平,同时测定患者每次透析前后血压、心率变化,并记录透析超滤量。结果低钙透析液(1.25mmol/l)透析时,血钙水平下降(2.38±0.14vs2.25±0.18mmol/l,P<0.01),QTc间期延长(405±27vs424±37ms,P<0.01),QTc离散度增加(41±26vs71±37ms,P<0.01)。QTc间期的变化与血钙浓度的变化呈负相关(r=-0.282,P=0.0068)。1.5mmol/l透析液透析时,血钙浓度无明显变化(2.30±0.21vs2.46±0.19mmol/l,P>0.05),QTc间期与QTc离散度也无明显改变。用两种钙离子浓度透析液透析时,血生化(磷、氯、钠、钾、HCO3-)变化水平均无明显差异,患者的平均动脉压、心率和超滤量无明显差别。结论低钙透析使QTc间期延长,QTc离散度增加:表明血清钙浓度的变化影响心肌电传导时间,QTc离散度的增加使心室复极异常,易引起室性心律失常,为心血管疾病患者死亡率增加的独立危险因素。因此,对有心脏�Objective In order to discuss the influence of dialysate with different calcium concentration on myocardial electrophysiological stability of patients on hemodialysis this paper observes QT interval and the change of QT dispersion of EKG with different calcium concentration. Methods There are 18 patients with uremic maintenance hemodialysis （ male/female 9/9, mean ages 58.65± 11.34 ）. Because of secondary hyperparathyroidism and hyperphosphatemia hemodialyze to the patients with low calcium dialysate, twice or three times a week, all patients have no history of coronary artery disease. All the patients were dialyzed with two kinds of dialysate with different calcium concentration （ 1.25 mmol/1, 1.5 mmol/ 1） , make a comparison study, observe EKG before and after dialysis, and determine blood biochemical parameters regularly including blood calcium, phosphorus, chlorine, sodium, potassium, HCO3^- and meanwhile determine the blood pressure, the change of heart rate before and after dialysis every time and record ultrafiltration volume. Results During dialysis with low calcium dialysate （ 1.25 mmol/l） the level of blood calcium decreased （ 2.38 ±0. 14 vs 2.25 ±0.18 mmol/1, P 〈 0.01）, QTc interval prolonged （405±27 vs 424±37 ms,P 〈0.01）,QTc dispersion increased（41±26 vs 71 ±37 ms,P 〈0.01）. The change of QTc interval and the change of blood calcium concentration had negative correlation （r = -0.282,P = 0. 0068）. While dialyzing with 1.5mmol/1 dialysate there was no significant change on blood calcium concentration（2.30±0.21 vs 2.46±0.19 mmol/l,P 〉0.05 ） , and also on QTc interval and QTc dispersion. While dialyzing with two kinds of dialysate with different calcium concentration there was no significant difference on the blood biochemical parameters including phosphorus, chlorine, sodium, potassium, HCO3^-, and there was also no significant difference on mean arterial pressure （MAP} , heart rate and ultrafiltration volume. Conclusion Dialysis with low calcium makes QT

关 键 词：低钙透析液 QTC离散度 

分 类 号：R459.5[医药卫生—治疗学]