维持性血液透析患者室性心律失常及其影响因素分析  

Analysis of Ventricular Arrhythmia and Its Influencing Factors of Patients with Maintenance Hemodialysis

作　　者：李瑾瑜[1] 覃晓波[2] 唐业莹[1] 吴洁[2] LI Jin-yu;QIN Xiao-bo;TANG Ye-ying;WU Jie(Department of Nephrology,Guangxi Zhuang Autonomous Region People＇s Hospital,Nanning,Guangxi,530021 China;Department of Eleetroeardiography,Guangxi Zhuang Autonomous Region People＇s Hospital,Nanning,Guangxi,530021 China)

机构地区：[1]广西壮族自治区人民医院肾内科,广西南宁530021 [2]广西壮族自治区人民医院心电诊断科,广西南宁530021

出　　处：《系统医学》2018年第10期5-6,10,共3页Systems Medicine

基　　金：广西壮族自治区卫生厅医疗卫生科研项目(Z2012326)

摘　　要：目的探讨维持性血液透析(MHD)患者室性心律失常(VA)发生情况及其影响因素,以及血液透析(HD)过程对VA发生率的影响。方法选取2015年8月—2017年8月在广西壮族自治区人民医院血液透析中心进行MHD的患者120例,血液透析前8 h安装24 h动态心电图记录仪,监测24 h VA的发生率,根据VA Lown,s分级分为A组(Lown,s0~Ⅰ级),B组(Lown,sⅡ~Ⅴ级)。HD前后测定血压,血钾(K^+),钠(Na^+),氯(Cl^-),钙(Ca^(2+)),血尿素氮(BUN),肌酐(Cr)。结果 HD过程中室性早搏的发生率43.5%高于其他时间段,差异有统计学意义(P<0.05)。Logistic回归分析发现年龄≥50岁(OR=1.27,P=0.002)、透析龄(12个月)(OR=1.06,P=0.000)、超滤量≥3 kg(OR=1.40,P=0.045)、血红蛋白<80 g/L(OR=1.20,P=0.000),缺血性心脏病(OR=5.28,P=0.000)是Lown,sⅡ级以上VA发生的危险因素。结论 MHD患者HD过程中VA明显增加,Lown,sⅡ级以上VA发生可能与年龄、血透龄、超滤量、贫血、缺血性心脏病等因素有关。Objective To study the ventricular arrhythmia and its influencing factors of patients with maintenance hemodialysis and effect on the incidence rate of VA in the HD course. Methods 120 cases of MHD patients in our hospital from August 2015 to August 2017 were selected, 24 h dynamic electrocardiogram recorder was fixed in 8 h before hemodialysis, and the incidence rate of VA at 24 h was monitored, and the patients were divided into the group A（Lown, s0-I） and the group B（ Lown, sⅡ-Ⅴ） according to the VA Lown, s classification, and the blood pressure,（K＋）,（Na＋）,（Cl-）,（Ca2＋）,（BUN）,（Cr） before and after HD were measured. Results The incidence rate of premature ventricular extrasystole 43.5%in the HD course was higher than the other time periods, and the difference was statistically significant（P〈0.05）, and the logistic regression analysis showed that the age above 50 years（OR=1.27, P=0.002）, dialysis age（December）（OR =1.06, P =0.000）, ultrafiltration more than 3 kg（OR =1.40, P =0.045）, hemoglobin 80 g/L（OR =1.20, P=0.000）, ischemic heart disease（OR =5.28, P=0.000） were the risk factors of VA more than level Lown, s Ⅱ.Conclusion The VA of MHD patients in the HD course obviously increases, and the VAS more than level Lown, sⅡmay be related to the age, hemodialysis, ultrafiltration, anemia and ischemic heart disease.

关 键 词：维持性血液透析 室性心律失常 影响因素 

分 类 号：R459.5[医药卫生—治疗学]