维持性血液透析相关心肌抑顿危险因素分析  

Risk factors for hernodialysis-related myocardial stmming among maintenance hemodialysis patients

作　　者：程明[1] 杨明[1] 王海兵[2] 韩帅[3] 张波[1] 宫婵娟 赵学智[1] 吴宗贵[2] 梅长林[1] 

机构地区：[1]第二军医大学附属长征医院肾内科,上海200003 [2]第二军医大学附属长征医院心内科,上海200003 [3]第二军医大学附属长征医院骨肿瘤科,上海200003

出　　处：《国际移植与血液净化杂志》2015年第6期23-28,共6页International Journal of Transplantation and Hemopurification

摘　　要：目的探索和分析透析相关心肌顿抑的危险因素。方法选取在本中心持续稳定血液透析6个月以上的患者236例。所有患者透析前、透析结束前15min和透析结束后30min接受超声心动图检查，观察心肌顿抑现象。连续监测血压等血流动力学指标12个月。每月监测患者血红蛋白、血脂、血浆白蛋白、NT-proBNP、肌钙蛋白T、Kt／Vurea。结果有151例（64．0％）患者在随访期间发生了透析相关心肌顿抑。发生透析相关心肌顿抑的患者年龄大[（65．95±12．50）vs（57．23±13．11）岁，P〈0．001]，糖尿病患病比例高（48．3vs20．0％，P〈0．001），高血压患病比例高（68．4％vs55．1％，P=0．006）。发生心肌顿抑的患者透析前收缩压较低[（139±22）vs（146±26）mmHg，1mmHg=0．133kPa，P=0．008]，均次超滤量高[（2．50±0．89）vs（1．25±0．26）L，P〈0．001）]，超滤速率快[（11．20±5．08）vs（7．65±3．52）ml／（kg·h），P〈0．1301]，透析中低血压发生较多（41．7％vs21．1％，P=0．001）。心肌顿抑组患者左心室射血分数（58．7％±7．8％vs64．5％±8．5％，P〈0．001）及左心室短轴缩短率（41．0％±7．5％掷45．1％±8．5％，P〈0．001）较低。心肌顿抑组患者血红蛋白水平[（99±9）vs（105±9）g／L，P〈0．001]较低，NT-pro BNP（6663±4330vs4916±3301，P=0．005）、肌钙蛋白T（42．9±18．4vs22．6±14．8，P=0．001）较高。logistic逐步回归显示，年龄〉60岁、透析时间〉48个月、患有糖尿病、患有高血压、发生透析中低血压、超滤量〉2．0L、超滤速率〉10ml／（kg·h）、血红蛋白〈100g／L、肌钙蛋白T〉30ng／L是透析相关心肌顿抑的独立危险因素（P〈0．05）。结论患者高龄、透析病程长、患有糖尿病、高血压、均次透析超滤量大、超滤速率快、贫血、肌钙蛋白T升高是发生透析相关心肌顿抑的危险因素。Objective To explore and analyze the dialysis-related risk factors for myocardial stunning. Methods Patients who underwent hemodialysis for more than 6 months were rescruited. All the patients accepted echocardiography before dialysis, 15 min or 30 min before the end and after the end of dialysis. Blood pressure and other hemodynamic parameters wene continuously observed for 12 months. Hemoglobin, lipids, serum albumin, NT-proBNP, troponin T and Kt / Vurea were monitored. Results There were 151 （64. 0%） patients developed dialysis-related myocardial stunning. Dialysis-related myocardial stunning occured in older patients （（65.95± 12.50） vs （57.23 ± 13. 11）y, P 〈 0.001）. Diabetes（48.3% vs 20.0%, P〈 0.001） and hypertension（68.4% vs 55.1%, P = 0.006）prevalence were higher in the patients who developed myocardial stunning. Predialysis systolic blood pressure （ （ 139 ± 22） vs （146±26） mmHg, 1 mmHg=0.133 kPa, P=0.008） were lower, as ultrafihration （2.50±0.89 vs 1.25±0.261, P〈0.001） and tthrafiltration rate （（11.20±5.08） vs （7.65 ± 3.52） ml/（kg·h）, P 〈0.001） were higher in patients with myocardial stunning. Intradialysis hypotension （41.7% vs 21.1%, P=0.001） occurred more. Left ventricular ejection fraction （58.7% ± 7.8% vs 64.5% ± 8.5%, P 〈 0.001） and left ventricular shortening fraction （41.0% ± 7.5% vs 45.1% ± 8.5%, P 〈 0. 001 ） were lower in myocardial stunning group compared with the others. Hemoglobin levels in patients with myocardial stunning （（99 ± 9） vs （105 ± 9） g/L, P 〈 0.001） were lower, NT-pro BNP （6663 ± 4330 vs 4916 ± 3301, P = 0.005） and troponin T （42.9 ± 18.4 vs 22.6 ± 14.8, P = 0.001 ） higher. In logistic regression, age 〉 60 years, dialysis duration 〉 48 months, suffering from diabetes, hypertension, dialysis hypotension, ultrafiltration volume 〉 2.0 L, uhrafiltration rate 〉 10 ml/（kg·h）, hemoglobin 〈 100 g/L and troponin T 〉 30 ng/L were independent risk factors

关 键 词：血液透析 心肌顿抑 危险因素 超滤 肌钙蛋白T 

分 类 号：R459.5[医药卫生—治疗学]