不同心功能状态下血液透析患者血液动力学变化及其影响因素  

Haemodynamic change and associated factors analysis in maintenance hemodialysis patients with different cardiac function

作　　者：叶文玲[1] 马杰[1] 石涛[1] 孙威[1] 李雪梅[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院肾内科,北京100730

出　　处：《中华肾脏病杂志》2012年第9期692-697,共6页Chinese Journal of Nephrology

基　　金：十二五国家科技支撑计划（2011BAI10B02）;北京协和医院科研处面上青年基金（2009155）

摘　　要：目的 研究维持性血液透析患者血液透析过程中血液动力学变化,探讨不同心功能状态下的血液动力学改变及其影响因素.方法 收集本院规律性血液透析患者临床资料,采用超声稀释法检测患者动静脉内瘘流量（Qa）和透析后1h、2h和3h的血液动力学指标,包括心输出量（CO）、心搏出量（SV）、心脏指数（CI）、中心血容量（CBV）、中心血容量指数（ CBVI）、外周血管阻力（PR）等参数.结果 75例患者平均年龄为（55.84±12.39）（21 ～81）岁,女性占57.3％.随着透析的进行,患者收缩压、SV、CO、CI及CBV显著下降,PR增加,而舒张压及心率的变化差异无统计学意义.根据透析后1 hCI值,将患者分为＜2.5 L·min-1·（m2）-1组、2.5～4.2 L·min-1· （m2）-1组和＞4.2 L·min-1·（m2）-1 3组.前两组患者透析3h后SV、CO、CBV较透析1h明显下降,PR增高（P均＜0.01）,CI＜2.5 L·min-1· （m2）-1组最为明显,而CI＞4.2 L·min-1·（ m2）-1组前后血液动力学指标无明显差异.CI与Qa、收缩压、平均动脉压、年龄、糖尿病、PR相关.结论 血液透析过程血液动力学改变表现主要为血压、CO、CI以及CBV降低,PR增高.不同CI患者透析过程中血液动力学改变程度不同,CI＜2.5 L·min-1· （m2）-1组患者血液动力学改变最为明显.CI与Qa、收缩压、年龄、糖尿病有相关关系.Objective To investigate haemodynamic change during hemodialysis and analyze effects of cardiac index （CI） on hemodynamic parameters and associated influencing factors in maintenance hemodialysis （MHD） patients.Methods Seventy-five patients bearing an arteriovenous fistula （AVF） entered the study.Cardiac output （CO）,cardiac index （CI）,central blood volume （CBV） and peripheral vascular resistance （PR） were determined by ultrasound dilution technique at the end of 1 hour,2 hours and 3 hours of dialysis.AVF blood flow （Qa） was also measured with the same device before haemodynamic parameters investigation.Results Mean age of patients was （55.84 ±12.39） years old （range 21-81 years） and 43 patients （57.3%） were female.Systolic arterial pressure,SV,CO,CI and CBV were significantly declined and no significant change for diastolic arterial pressure and heart rates at the end of 2 hour and 3 hour hemodialysis,whereas PR was increased gradually during hemodialysis.Patients were divided into there groups with CI less than 2.5 L·min 1·（m2）-1,2.5-4.2 L·min-1·（m2）-1 and more than 4.2 L·min-1 ·（m2）-1 at the end of 1 hour dialysis.Statistically significant decreasing SV,CO and increasing PR were detected in patients with CI〈2.5 L·min-1· （m2）-1 and 2.5-4.2 L· min-1· （m2）-1,compared with CI〉4.2 L·min-1· （m2）-1 group （P〈0.01）.The hemodynamic change was the most obvious in the group of CI less than 2.5 L· min-1· （m2） 1,and no significant changes happened in CI〉4.2 L·min-1 ·（m2）-1 group.Some factors were found to be associated to CI values.Qa and systolic arterial pressure had positive relationship with CI,while age and diabetes had negative relationship with CI.Conclusions Systolic arterial pressure,CO,CI and CBV decrease and PR increases during hemodialysis.Obvious change occurs when CI is less than 2.5 L·min-1· （m2）-1.CI is associated with Qa,systolic arterial pressure,age and diabetes.

关 键 词：血液透析 血流动力学 心脏指数 

分 类 号：R459.5[医药卫生—治疗学]