不同红细胞压积水平对血液透析患者心脏功能及结构的影响  

Effect of hematocrit levels on cardiac function and structure in hemodialysis patients

作　　者：周长学[1] 陈兵[2] 王继军[1] 王荣[2] 

机构地区：[1]枣庄市立医院肾内科,277102 [2]山东大学附属省立医院肾内科

出　　处：《国际移植与血液净化杂志》2014年第3期30-33,共4页International Journal of Transplantation and Hemopurification

摘　　要：目的 探讨不同红细胞压积（HCT）水平对血液透析患者心脏功能及结构的影响.方法 纳入2011年6月1日至2012年5月31日枣庄市立医院维持性血液透析患者69例,透析时间最短为6个月.所有患者按照HCT水平分为5组：A组（10％≤HCT＜ 20％）9例,B组（20％≤HCT＜25％）18例,C组（25％≤HCT＜ 30％）21例,D组（30％≤HCT＜ 33％）14例,E组（HCT≥33％）7例.按照随机区组方差分析方法进行统计,分析各组透析患者心功能指标的差异,及其随不同HCT水平的变化趋势.结果 患者左心室射血分数（LVEF）水平随着HCT的升高逐渐升高,A～E组分别为（47.7±6.5）％、（55.8±1.3）％、（51.5±12.7）％、（56.7±9.5）％和（68.5±4.0）％,E组LVEF高于D组（P＜0.05）.A～E组左心室收缩末内径（LVESD）分别为（38.0±7.3）、（32.4±5.9）、（41.8±9.9）、（39.3±7.7）和（33.2± 1.0）mm,C组高于B组（P＜0.05）.结论 当HCT水平达到33％（血红蛋白＞110 g/L）以上并长期维持可明显改善维持性血液透析患者左心收缩功能,并减少心力衰竭的发生,对左心室肥厚亦有逆转的趋势.Objective The effect of hematocrit levels on cardiac function and structure in hemodialysis patients will be investigated,providing some clues for the clinical goals enacting in renal anemia patients.Methods About 69 hospitalized uremia patients receiving regular hemodialysis treatment at least 6 months between January 2011 and June 2012 in the hemodialysis center of Zaozhuang Municipal Hospital were collected in the study.The effect of hematocrit levels on cardiac function and structure in hemodialysis patients was inspected.The 69 uremia patients were divided into 5 groups according to the levels of HCT：group A （10％≤HCT＜ 20％） 9 cases,group B （20％≤HCT＜25％） 18 cases,group C （25％ ≤HCT ＜30％） 21 cases,group D （30％ ≤HCT＜ 33％） 14 cases,and group E （HCT≥33％） 7 cases.The difference in cardiac function indexes among the 5 groups was determined by Randomized Block Design Analysis of Variance （ANOVA）,and the HCT related changing trends were also investigated.Results As the HCT rises,levels of LVEF were grown up accordingly,group A to group E was （47.7 ± 6.5）％,（55.8±1.3）％,（51.5± 12.7）％,（56.7±9.5）％ and（68.5 ± 4.0）％,respectively; LVEF of group E was higher than group D.LVESD of group A to group E was （38.0 ± 7.3）,（32.4 ± 5.9）,（41.8 ± 9.9）,（39.3 ± 7.7） and （33.2 ± 1.0）mm,respectively; statistical significance was found between group B and group C（P ＜ 0.05）.Conclusions The higher levels of HCT （≥ 33 ％） and long-term maintenance may significantly improve the left ventricular systolic function and reduce the chances of heart failure in hemodialysis patients.It also has the trend to reverse the left ventricular hypertrophy.

关 键 词：肾透析 肾功能衰竭 慢性 血细胞比容 心力衰竭 

分 类 号：R692.5[医药卫生—泌尿科学]