大剂量左卡尼汀在不能耐受血液透析的尿毒症合并心脏病患者中的应用  

Supplementation with high-dose L-carnitine on hemodialysis tolerance in uremic patients with severe heart diseases

作　　者：潘月娟 卢方平[1] 

机构地区：[1]清华大学第一医院肾内科,北京100016

出　　处：《中华医学杂志》2017年第48期3792-3795,共4页National Medical Journal of China

摘　　要：目的探讨静脉注射大剂量左卡尼汀治疗不能耐受血液透析的尿毒症合并严重心脏疾病（心绞痛、心肌梗死、充血性心力衰竭、心律失常）患者的效果。方法回顾性分析2012年3月至2017年3月在清华大学第一医院肾内科住院的因心脏病不能耐受维持性血液透析的尿毒症患者资料。患者在血液透析中出现症状性低血压、胸闷、喘憋、心慌、胸痛等症状，不耐受设定目标时间的血液透析治疗。在常规治疗的基础上使用大剂量左卡尼汀5g／次，治疗2周，比较治疗前后患者耐受血液透析时间、心功能分级、透析中低血压发生、心律失常及心绞痛等情况。结果入选29例患者，其中男14例，女15例，年龄31～86（67．2±11．5）岁，治疗后患者透析耐受时间明显延长，由治疗前2．0～3．5（2．6±0．4）h，增加至治疗后3．0～4．0（3．8±0．4）h（t=10．66，P〈0．01）。治疗前心功能分级[纽约心脏病学会（NYHA）分级]为4级19例，3级10例；治疗后1级2例，2级19例，3级8例，4级0例，治疗后心功能分级明显改善（Z=-4．74，P〈0．01），透析中不适症状减少，透析耐受性明显改善。结论大剂量左卡尼汀可改善合并严重心脏病的血液透析患者心衰、心律失常、缺血的症状及心功能，帮助患者更好地耐受血液透析治疗。Objective To investigate the effect of intravenous supplementation with high-dose L-caruitinen on hemodialysis tolerance in uremic patients with severe heart disease （isehemie heart disease, congestive heart disease and arrhythmia） . Methods Between March 2012 and March 2017, 5 gram L-camitine was given after the completion of each hemodialysis treatment （3 -4 times a week） over a period of two weeks in 29 maintenance hemodialysis patients with severe heart diseases manifested by frequently symptomatic hypotension, chest tightness, wheezing, palpitation, chest pain and other symptoms during hemodialysis. The hemodialysis duration, heart functional classification （New York Heart Association Functional Classification, NYHA ）, blood pressure and arrhythmia were analyzed before and after the treatment. Results The duration of hemodialysis was significantly prolonged after treatment [ from 2. 0 - 3.5 （2. 6 ±0. 4）h to 3.0 -4. 0 （3.8±0. 4） h, t = 10. 66,P 〈0. 01 ]. Cardiac function was improved （Z = -4. 74, P 〈 0. 01 ）. The hypotension and arrhythmia during dialysis was improved. Conclusion Highdose of intravenous L-earnitine supplementation can improve hemodialysis tolerance and the symptoms of heart failure, arrhythmia, isehemie cardiac disease in hemodialysis patients with severe heart diseases.

关 键 词：血液透析 心脏病 肉碱 耐受性 

分 类 号：R541[医药卫生—心血管疾病] R692.5[医药卫生—内科学]