维持性血液透析患者动静脉内瘘功能与左心室功能的相关性分析  

Analysis of arteriovenous fistula function and left ventricular dysfunction in patients on maintained hemodialysis

作　　者：王立华[1] 姜埃利[1] 刘学玲[1] 魏芳[1] 

机构地区：[1]天津医科大学第二医院肾脏病血液净化科,天津300211

出　　处：《临床心血管病杂志》2014年第8期709-711,共3页Journal of Clinical Cardiology

基　　金：天津市卫生行业2012重点攻关项目(No:12KG136)

摘　　要：目的：对维持性血液透析患者动静脉内瘘功能与左心室功能的相关性进行分析。方法：选取我院肾脏病血液净化科2011-2012年收治的维持性血液透析治疗患者138例,进行前瞻性队列研究。对所有患者均常规检测各项生化指标;利用超声稀释法检测内瘘功能、血流动力学指标;利用彩色多普勒检测内瘘侧头静脉及桡动脉血管直径及血流量,利用超声心动图检查评价左心室功能,随访观察18~30个月。结果：内瘘血流量〈600ml/min患者34例,内瘘血流量〉600ml/min患者104例,不同内瘘血流量患者内瘘功能及左心室功能指标差异无统计学意义。多因素Logistic回归分析显示,血浆白蛋白与超敏C反应蛋白水平是患者左室收缩功能障碍的危险因素,而年龄、血清胆固醇水平、内瘘侧头静脉和桡动脉直径是患者左室舒张功能障碍的危险因素。Cox回归模型提示,性别、甲状旁腺激素以及超敏C反应蛋白是患者死亡的独立危险因素。结论：维持性血液透析治疗患者普遍存在左心室肥厚,而内瘘流量与心功能之间尚不存在明确的因果关系。Objective：To investigate arteriovenous fistula function and left ventricular dysfunction in patients on maintained hemodialysis. Method： A total of 138 patients who received maintained hemodialysis were included in this study. Patients were divided into two groups： Qa〈600 ml/min group and Qa〉600 ml/min group. Blood examinations such as blood urine nitrogen, creatinine, hemoglobin, calcium, phosphate, triglyceride, total choles- terol, LDL-C, HDL-C, hs-CRP, parathyroid hormone and level of homocysteine were measured. We monitored the parameters of Qa in arteriovenous fistula, cardiac output and cardiac index by using Transonic HD02. The changes of Qa and the effect of hemodynamic changes on Qa were evaluated. We also evaluated the diameters of in- ternal fistula vessels including cephalic vein, radial artery and brachial artery, and the mean velocity of blood flow in the fistulay color Doppler ultrasonog-raphy. The patients were followed up for 18 to 30 months. Result.. Left ventrieular dysfunction existed in both groups, but there was no significant difference. The inner diameters of ce- phalic vein and radial artery, and the velocity of blood flow in radial and brachial arteries were significantly differ- ent between patients with lower Qa and those with higher Qa. Significant differences were found between elderly patient group and health control group（P〈0.05）. The level of albumin, and hs-CRP were risk factors for left ven- tricular systolic dysfunction, while age,TC, diameters of adial artery and brachial artery were risk factors for left ventricular diastolic dysfunction. Kaplan-Meier survival curves showed that the morbidity of CVD events was en- haneed at Qa〉600 ml/min, and sex, PTH, hs-CRP were the independent risk factors of CVD events for the patients with hemodialysis by COX regression. Conclusion： There is left ventricular hypertrophy in patients on main- tained hemodialysis. But there is no relationship between blood flow access and cardiofucntion.

关 键 词：血液透析 动静脉内瘘 左心室肥厚 超声稀释技术 

分 类 号：R541.6[医药卫生—心血管疾病]