不同透析方式对尿毒症患者心脏结构及功能的影响  

Effects of different dialysis methods on cardiac structure and function of uremic patients

作　　者：黄雅清[1] 俞国庆[1] 王强[1] 林强[1] 庄永泽[1] 

机构地区：[1]南京军区福州总医院肾内科,福州350025

出　　处：《临床肾脏病杂志》2017年第1期20-23,共4页Journal Of Clinical Nephrology

基　　金：福建省自然基金面上项目(No.2014J01426)

摘　　要：目的探讨不同透析方式对尿毒症患者心脏结构和功能的影响,研究其相关影响因素。方法收集2012~2015年在南京军区福州总医院行透析治疗的患者63例,根据透析方式分为腹透组和血透组,2组患者在透析前后均行心脏彩超检查,收集患者透析前后的一般资料及心脏彩超各项指标包括心脏室间隔厚度、左心室后壁厚度、左心室舒张末期内径,左心房前后径,左心室射血分数,并计算左心室心肌重量指数。比较2组患者上述指标在透析前后组间及组内的差异,并分析其相关影响因素。结果在透析前,2组患者残余尿量、平均动脉压、血白蛋白比较差异无统计学意义;而在透析后与血透组比较,腹透组的残余尿量、平均动脉压均偏高,血白蛋白偏低,差异有的统计学意义(P<0.05)。与透析前比较,透析后2组血钙浓度均升高,差异有统计学意义(P<0.05)。在透析后,腹透组的胆固醇、低密度脂蛋白浓度较血透组高,差异具有统计学意义(P<0.05)。在透析前,2组患者心脏各项指标无明显差异;透析后2组患者的左心室心肌重量指数、室间隔厚度、左心室后壁厚度值明显升高(P<0.05)。左心室心肌重量指数与收缩压成正相关(r=0.382,P<0.05),与血红蛋白、低密度脂蛋白、残余尿量呈负相关(r=-0.303、-0.253、-0.4,P<0.05或P<0.01)。结论透析会影响尿毒症患者心脏结构和功能,且血液透析的影响可能更大,这可能与患者的残余肾功能、血压、贫血、低密度脂蛋白等因素有关,提示应对透析患者提早进行干预,改善心肌肥厚。Objective To investigate the influence of different dialysis methods on cardiac structure and function in patients with uremia, and to study the related influencing factors. Methods The patients （n = 63） who had received dialysis in Nanjing General Hospital of Fuzhou Military from 2012 to 2015 were selected and divided into peritoneal dialysis （PD） group （n = 32） and hemodialysis （HD） group （n = 31）. The cardiac ultrasound examination was performed before and after dialysis in both two groups. The general information, as well as echocardiography indexes including IVST, LVWPT, LVDd, LAD and LVEF was collected. The left ventricular mass index （LVMI） was calculated. The differences between the groups before and after dialysis were compared, and the related influencing factors were analyzed. Results The general information of two groups had no significant difference. After dialysis the urine volume in PD group was greater than in HD group, but there was no significant difference before the dialysis. There was no significant difference between the two groups in car diae indexes before dialysis. After dialysis, the LVMI in two groups was significantly increased than before dialysis （P〈0. 05）. LVMI, IVST and LVWPT were significantly increased in HD group as compared with those in PD group. LVMI was positively related with systolic blood pressure （r = 0. 382, P〈0. 05）, and negatively with hemoglobin, LDL and residual urine volume （r = - 0. 303,- 0. 253, - 0. 4; P〈0. 05 or P〈0. 01, respectively）. Conclusions Dialysis can affect the cardiac structure and function in patients with uremia, and HD may be grater, which may be related to residual renal function, blood pressure, anemia, LDL and other factors. This reminded us that we should early prevent and improve the cardiac function in dialysis patients.

关 键 词：腹膜透析 血液透析 尿毒症 心脏功能 

分 类 号：R692.5[医药卫生—泌尿科学]