年龄对维持性血液透析尿毒症患者右心室功能影响的研究  

Association between right ventricular function and age in uremic patients with maintenance hemodialysis

作　　者：高继康[1] 梅旭峰[2] 沈军[2] 庄国华[2] 张云龙 GAO Jikang;MEI Xufeng;SHEN Jun(Department of Ultrasonography,First People's Hospital of Yuhang District,Hangzhou 311100,China)

机构地区：[1]杭州市余杭区第一人民医院超声科,311100 [2]杭州市余杭区第一人民医院血透室,311100

出　　处：《浙江医学》2018年第6期612-615,共4页Zhejiang Medical Journal

基　　金：杭州市卫生科技计划项目(2014B30)

摘　　要：目的探讨年龄对维持性血液透析尿毒症患者右心室功能的影响。方法选取维持性血液透析尿毒症患者135例和正常体检者41例,采用组织速度、组织追踪、应变和应变率显像测定右心室前、下、侧壁基底段的收缩期组织速度(AVbs、IVbs、LVb s)、位移(ADb s、IDb s、LDb s)、应变(ASb s、ISb s、LSb s)和应变率(ASRb s、ISRb s、LSRb s);采用双平面法测定右心室舒张及收缩末期容积(RVEDV、RVESV),右心室输出量(RVCO)、右心室每搏输出量(RVSV)、右心室射血分数(RVEF);利用瓣环运动定量软件测定三尖瓣环中点位移和位移率(TAD与TADr)。将年龄分别与右心室壁各基底段的Vs、Ds、SRs和Ss以及RVEDV、RVESV、RVCO、RVSV、RVEF进行直线回归分析。结果在尿毒症组,绝大多数右心室壁基底段的组织多普勒参数测值(IVb s、IDb s、LDb s、ASRb s、ISRb s、LSRb s)小于正常对照组;RVEDV、RVESV、RVSV、RVEF、TAD、TADr测值均小于正常对照组(均P<0.05);年龄与部分组织多普勒参数(LVbs、LDbs、ASRbs、ISbs、LSbs)呈负相关,其中与右心室侧壁基底段收缩期位移(LDbs)及下壁基底段收缩期应变(ISbs)相关性较高(均r=-0.32,P<0.01);年龄与RVEDV、RVESV、RVSV均呈负相关,其中与RVEDV相关性较高(r=-0.21,P<0.05);年龄与TAD及TADr均呈负相关,其中与TAD相关性较高(r=-0.39,P<0.01)。结论年龄的增长可加重维持性血液透析尿毒症患者的右心室功能的损害。Objective To investigate the association between right ventricular functions and age in uremic patients with maintenance hemodialysis.Methods One hundred and thirty five patients with uremia undergoing maintenance hemodialysis(uremia group)and 41 healthy subjects(control group)were enrolled.The systolic tissue velocity,systolic displacement,systolic strain and systolic strain rate of basal segments of anterior,inferior,lateral walls of right ventricle(AVbs,IVbs,LVbs,ADbs,IDbs,LDbs,ASbs,ISbs,LSbs,ASRbs,ISRbs,LSRbs)were measured by tissue velocity imaging,tissue track imaging,strain imaging and strain rate imaging.The right ventricular end diastolic and systolic volume(RVEDV,RVESV),right ventricular cardiac output(RVCO),right ventricular stroke volume(RVSV),right ventricular ejection fraction(RVEF)were measured by bi-plane method.The tricuspid annulus midpoint displacement(TAD),tricuspid annulus midpoint displacement rate(TADr)were measured by annulus motions quantitative software.The linear regression was used to analyze the association between the ages and Vs,Ds,Ss,SRs of every basal segment of right ventricle walls,and RVEDV,RVESV,RVCO,RVEF,RVSV,TAD,TADr.Results The tissue Doppler parameters IVbs,IDbs,LDbs,ASRbs,ISRbs,LSRbs in uremia group were lower than those in control group,and the means of RVEDV,RVSV,RVESV,RVEF,TAD,TADr were all less than those in control group(P<0.05).The tissue Doppler parameters LVbs,LDbs,ASRbs,ISbs,LSbs were negatively correlated with the age of uremic patients,particularly for LDbs and ISbs(both r=0.32,P<0.01;Y=-0.10X+17.82 and Y=-0.21X+32.67,respectively);the RVEDV,RVESV,RVSV were negatively correlated with the age of patients,particularly for RVEDV(r=-0.21,P<0.05,Y=-0.24X+55.20);the TAD and TADr were also negatively correlated with the age of patients,particularly for TAD(r=-0.39,P<0.01,Y=-0.14X+21.99).Conclusion The damage of the right ventricular function is aggravated with the increasing age in uremic patients with maintenance hemodialysis.

关 键 词：超声心动描记术 尿毒症 右心室 心功能 年龄 

分 类 号：R692.5[医药卫生—泌尿科学]