超高龄患者持续肾脏替代疗法开始时的心血管状态及超声心动图特点  

Cardiovascular disease and echocardiographic characteristics in elderly patients starting CRRT

作　　者：陆文俊[1] 孙建设[1] 张晓丽[1] 张音佳[1] 吴毓敏[1] 夏世金[2] 

机构地区：[1]复旦大学附属华东医院肾内科,上海200040 [2]复旦大学附属华东医院上海市老年医学研究所

出　　处：《中国老年学杂志》2013年第5期995-997,共3页Chinese Journal of Gerontology

基　　金：国家自然科学基金(No.31171129)

摘　　要：目的了解持续床旁持续肾脏替代治疗(CRRT)的超高龄患者开始治疗时的心血管状态和超声心动图(UCG)特点。方法选择该院开始床旁CRRT病例43例,收集当时血压、症状(如气急等)、体征(胸水、水肿等)、实验室检查数据和UCG资料。计算心血管并发症和UCG异常发生率。分析UCG异常及相关因素。结果 CRRT开始时的心血管并发症:高血压41.9%、心律失常76.7%、心绞痛4.7%、收缩性心力衰竭18.6%、舒张性心力衰竭62.8%、周围血管病6.9%。UCG检出左心室肥厚(LVH)发生率39.5%,相关因素有高血压、贫血和低白蛋白血症有关。左室射血分数(LVEF)低于正常占18.6%,相关因素有缺血性心脏病、肺部感染、收缩压低等有关。左心室舒张功能不全占62.8%,相关因素有年龄、贫血和低白蛋白血症。结论 CRRT开始时患者心血管并发症和UCG异常的发生率很高。UCG异常和高龄、贫血、低白蛋白血症、高血压、缺血性心脏病、肺部感染有关。Objective To investigate the prevalence cardiovascular disease and its echocardiographic characteristics at the initiation of continuous renal replacement therapy （CRRT） in elderly patients with end-stage renal disease （ESRD）. Methods Fifty-eight elderly patients with ESRD, who had been examined by ultrasonic cardiography （UCG） at the initiation of CRRT, were investigated retrospectively. Their blood pressures, blood biochemistry and UCG findings were analyzed. UCG abnormalities and there risk factor were assessed by Pear- son linear correlation. Results The incidences of hypertension, ischemic heart disease （IHD） ,cardiac arrhythmia, left ventrieular systolic heart failure,left ventricular diastolic heart failure（DHF） and peripheral vascular disease at the initiation of CRRT were 41.9% , 76. 7%, 4. 7%, 18. 6% , 62. 8% and 7% respectively. UCG examination showed that 39. 5% had left ventricular hypertrophy （LVH）, 18.6% low LVEF,62. 8% Left ventricular diastolic heart failure. The independent risk factors for different UCG abnormalities were LVH-hypertension, anemia and hypoalbuminemia, low LVEF-decreased systolic blood pressure, ischemie heart disease and lung infection, DHF-age （elderly）, anemia and hypoalbuminemia. Conclusions The incidences of cardiovascular disease and UCG abnormalities are very high at the initiation of CRRT in elderly ESRD patients. UCG abnormalities correlate with elderly, anemia, hypoalbuminemia, hypertension, isehemie heart dis- ease and lung infection.

关 键 词：超高龄 持续肾脏替代疗法(CRRT) 心血管并发症 超声心动图 

分 类 号：R540[医药卫生—心血管疾病]