血液净化模式对维持性血液透析患者血压变异性的影响

目的:探讨不同血液净化模式对维持性血液透析(maintenance hemodialysi S,MHD)患者血压变异性(blood pressure variability,BPV)的影响。方法:选取我科血液透析中心MHD患者80例做横断面研究。其中30例为常规血透的患者,50例为组合式透析的患者。监测两组透析间期44h动态血压值、透析中血压值,计算收缩压(systolic b]oodpressure,SBP)、舒张压(diastolic blood pressure,DBP)的平均值和标准差(standard deviation,s D),以变异系数(coefficient of variation,CV)表示收缩压和舒张压BPV。比较不同治疗模式BPV的差异。结果:常规透析组和组合式透析组的透析间期平均收缩压(systolic blood pressure,SBP)分别为(155±4) mm Hg和(152±6) mm Hg,差异无统计学意义,SBP-SD分别为(13. 11±0. 57)mm Hg和(10. 21±0. 55) mm Hg,SBP-CV分别为(7. 54±0. 54)%和(4. 03±0. 62)%,差异有统计学意义(P 0. 05);两组透析间期平均舒张压(diastolic blood pressure,DBP)差异无统计学意义,而DBP-SD和DBP-CV差异有统计学意义(P 0. 05)。两组患者透析中平均SBP分别为(135±3) mm Hg和(145±7) mm Hg,SBP-SD分别为(9. 10±1. 39) mm Hg和(7. 19±1. 21) mm Hg,SBP-CV分别为(5. 51±0. 34)%和(3. 11±0. 83)%,差异均有统计学意义(P 0. 05),相似的,两组透析中平均舒张压(diastolic blood pressure,DBP)、DBP-SD及DBP-CV比较,差异均有统计学意义(P 0. 05)。结论:组合式透析模式较单纯普通血透模式的患者透析间期及透析中收缩压及舒张压变异性小,是一种比较推崇的透析模式。     

两种透析方式对终末期肾脏病患者肺动脉高压的影响及相关因素分析

目的：比较维持性血液透析（ MHD）及腹膜透析（ PD）患者合并肺动脉高压（ PHT）的发生率及相关影响因素，以早期诊断及干预。方法：选取我科2005年7月~2013年7月收治的MHD及PD患者，透析1年以上具有完整临床资料的患者分别120例、138例，超声心动图检测的PASP﹥35 mmHg诊断PHT。搜集MHD合并PHT组与PD合并PHT组患者的临床资料、实验室检查指标及心脏超声检查指标，采用多因素Logistic回归分析透析患者的PHT发生的相关因素。结果：（1） HD与PD患者发生PHT分别为45例（37．5%）与44例（31．8%），差异无统计学意义，与透析方式及透析时间长短均无显著相关性；（2）HD与PD患者发生PHT89例（34．5%），其中轻度PHT63例（70．8%），中度PHT21例（23．5%），重度PHT5例（5．6%），对PHT组与非PHT组患者舒张压（ DBP）、Alb、CRP、LEVD、LVEF、LAD进行比较，差异有统计学意义（ P﹤0．05），但血红蛋白、甲状旁腺素、血清肌酐比较，差异无统计学意义。结论：HD与PD患者PHT发生率相似，容量负荷过重，炎症状态及营养状态可能参与了PHT的发生。     

长期维持性血液透析患者并发的肺动脉高压

目的 研究长期维持性血液透析(MHD)患者肺动脉高压(PHT)的特征及相关因素.方法 参照2010年美国心脏超声协会右心检测指南,肺动脉收缩压(PASP)＞35 mm Hg诊为PHT.超声心动图和脉搏波传导速度(baPWV)于透析后次日集中检测.自体动静脉内瘘(AVF)流量采用超声稀释法检测.收集及评估患者的透析相关信息,取血检测血常规、钙、磷、甲状旁腺激素(iPTH)、肝肾功能等指标.结果 我院透析中心进行MHD 6个月以上,采用自体AVF并除外其他疾病引起并发PHT者,共111例,其中男性45例,女性66例,平均年龄( 57.32±12.49)岁,平均透析龄为(70.51±44.98)个月.28例诊为PHT,占25.23％,平均PASP为(45.68±10.83) mm Hg.PHT组的左室舒张功能不全明显较非PHT组常见(53.60％比6.02％,P＜0.01).PHT组左室射血分数(EF)值(62.06％±14.90％比69.72％±8.60％)、左室内径缩短分数(36.46％±10.04％比40.20％±7.86％)均低于非PHT组(均P＜0.01).EF＜50％者在PHT组和非PHT组分别占21.43％和3.61％.但PHT组和非PHT组在年龄、性别、透析龄、身高、体质量指数(BMl)、透析间期平均每日体质量增长、透析前血压、血红蛋白、血白蛋白、前白蛋白、血钙、血磷、iPTH、标准化蛋白分解率(nPCR)、Kt/V、baPWV以及AVF流量等差异均无统计学意义.结论 PHT是维持性血液透析常见的并发症,其发生与左室收缩和舒张功能下降密切相关;与钙磷代谢、AVF流量、血红蛋白、透析充分性及营养状态等无明显相关性.     

腹膜透析对视黄醇结合蛋白清除作用的初步研究

目的：测定腹膜透析对视黄醇结合蛋白（RBP）的清除作用。方法：采用酶联免疫法分别测定持续性非卧床腹膜透析（CAPD）组、维持性血液透析（MHD）组透析前后,以及正常对照组患者血清RBP,检测CAPD组24h腹膜透析置换液中RBP值及MHD组透析废液RBP值。结果：CAPD、MHD及正常对照组患者的血清RBP值分别为（74.67±17.23）mg/L、（100.84±2.95）mg/L及（37.89±3.21）mg/L,三组血清RBP有统计学意义（P〈0.001）;进行两两比较,正常组与CAPD组、正常组与MHD组、CAPD与MHD组比较,均有统计学意义（P〈0.001）。结论：维持性透析患者血清RBP明显高于正常人,其中CAPD患者血清RBP水平明显低于MHD患者;CAPD患者对于RBP的清除量和清除率明显高于MHD组,CAPD能清除血清中RBP,血液透析前后血清RBP无变化,HD对血清RBP基本无清除作用。     

不同血液净化方式对维持性血液透析患者贫血治疗的影响

目的比较单纯血液透析与血液透析联合血液灌流治疗对维持性血液透析（maintenance hemodialysis,MHD）患者贫血治疗的影响。方法选择2013年4月至11月在我院血液净化中心MHD患者40例,入组前患者均每周3次行单纯血液透析治疗,并使用促红细胞生成素刺激剂（eryhropoises stimulating agent,ESA）纠正贫血。按照随机数表法将MHD患者40例分为单纯血液透析（hemodialysis,HD）治疗组（HD组）和血液透析联合血液灌流（hemoperfusion,HP）治疗组（HD＋HP组）,每组20例。HD组仍每周3次均行HD治疗;HD＋HP组每周行2次HD治疗,1次HD＋HP治疗,仍继续使用ESA;治疗12周。记录2组患者治疗前、后血红蛋白（hemoglobin,Hb）,ESA用量,计算ESA抵抗指数（ESA resistant index,ESARI）评价ESA治疗的反应,同时检测2组治疗前、后血清铁、白蛋白（albumin,Alb）、C反应蛋白（c-reactiveprotein,CRP）、全段甲状旁腺素（intact parathyroidism hormone,iPTH）水平及透析治疗的单室模型尿素清除指数（singlepool Kt／V,spKt／V）。结果40例患者均随访至第12周末。第12周时,HD＋HP组患者Hb水平较基线时显著升高[（119．27±12．16）g／L比（106．59±6．51）g／L,（P〈0．01）],而ESA剂量低于基线时水平[（76．99±16．6）IU·W^-1·kg^-l比（128．96±33．47）IU·w^-1·kg^-1（P〈0．05）],ESARI亦低于基线时水平[（0．56±0．20）比（1．30±0．47）,（P〈0．01）]。第12周时HD＋HP组患者的iPTH水平较基线时显著降低[（161．09±63．70）ng／L比（256．23±56．77）ng／L,（P〈0．01）],CRP水平较基线时降低[（4．65±1．32）mg／L比（7．55±3．23）mg／L,（P〈0．05）];而第12周时HD组患者的Hb水平、ESA用量、ES—ARI值及iPTH、CRP水平与基线时比较无统计学差异（P〉0．05）。结论HD联合HP治疗较单纯HD治疗能更有效清除CRP、iPTH,提高MHD患者对ESA治疗的反应性,减少ESA使用剂量,改善MHD患者纠正贫血治疗的效果。     

血液灌流联合血液透析对血地高辛清除率的影响

目的观察血液灌流联合血液透析（HP＋HD）、血液透析（HD）对维持性血液透析（MHD）患者血地高辛清除率的影响。方法选择30例MHD患者每周行HP＋HD治疗1次、HD治疗2次,每次治疗4h。采用自身前后对照研究,每例患者分别观察HP＋HD治疗1次、HD治疗1次,总计60例次,分为HD＋HP组30例次和HD组30例次。观察2组透析前后血地高辛浓度、尿素氮（BUN）,比较2组治疗前后血地高辛浓度、地高辛清除率、尿素下降率（URR）和单室模型尿素清除指数（spKt／V）。结果2组治疗前血地高辛浓度、URR和spKt／V比较无统计学差异（P〉O．05）。2组治疗后血地高辛浓度均显著低于治疗前（P〈0．01）,但HD＋HP组血地高辛清除率明显高于HD组（P〈0．01）。结论两种透析方式对血液中地高辛均有清除作用,HP＋HD治疗对地高辛清除率较HD治疗效果高。     

维持性血液透析患者透析间期血压对残余肾功能的影响

目的:探讨维持性血液透析患者透析间期血压对残余肾功能的影响。方法:将2013年3月至2017年3月内蒙古科技大学包头医学院第一附属医院血液净化中心开始行血液透析的患者188例,开始透析3个月时进行胱抑素C的检侧,同时开始检测透析间期一周血压,计算平均血压值,根据不同平均收缩压值分为三组:A组:110 mm Hg,B组:110~160 mm Hg,C组:160 mm Hg;根据不同平均舒张压值再分为三组:a组:60 mm Hg,b组:60~90 mm Hg,c组:90 mm Hg。比较不同血压组间RRF(用血胱抑素C计算:RRF=0.70+22×1/Cys C)有何不同。结果:收缩压110 mm Hg和160 mm Hg组RRF明显低于110~160 mm Hg组(P0.001),而收缩压110 mm Hg组比收缩压160 mm Hg组RRF更低,但差异无统计学意义(P0.05);舒张压60mm Hg组的RRF明显低于舒张压在60~90 mm Hg组和舒张压90 mm Hg组(P0.001)。而舒张压在60~90 mm Hg组RRF明显高于舒张压90 mm Hg组(P0.001)。结论:控制透析间期高血压,并防止透析间期低血压发生可能有助于保护残余肾功能。患者舒张压过低可能加速残余肾功能的降低。     

维持性血液透析患者透析间期体质量增长及其影响因素

目的 了解维持性血液透析（MHD）患者透析间期的体质量增长情况及影响因素。 方法 对复旦大学中山医院肾脏科血液净化中心269例MHD患者作横断面研究。根据患者透析间期体质量增长率（体质量增长量/干体质量×100%）将患者分为≤3.50%（79例）及>3.50%（190例）两组,分析影响透析间期体质量增长的因素。 结果 269例MHD患者体质量增长量为（2.42±1.01） kg（0~6.33 kg）,体质量增长率为（4.25±1.79）%。男性160例,体质量增长量为（2.45±1.09） kg,体质量增长率为（3.99±1.79）%;女性109例,体质量增长量为（2.39±0.85）kg,体质量增长率为（4.64±1.74）%,显著高于男性（P < 0.01）。透析间期体质量增长率＜3.00%的患者占20%,≥3.00%且＜5.00%的占50%,≥5.00%占30%。73.5%的患者体质量增长率超过3.50%。与体质量增长率>3.50%组比较,≤3.50%组的年龄（岁）（60.50±14.49比54.07±13.78）、男性比例（70.88%比54.74%）、体质量指数（BMI,kg/m2）（22.67±3.36比20.91±3.25）、残余尿量（ml）（自然对数：6.19±0.94比5.48±0.81）、干体质量（kg,62.82±10.97比56.69±10.94）及透析频次明显较高（均P < 0.05）;血液透析龄（月）（41.03±41.92比58.83±43.57）,β2微球蛋白（mmol/L）（31.61±9.82比38.54±10.38）及血磷（mmol/L）（1.92±0.66比2.15±0.58）显著较低（均P < 0.05）。相关分析显示体质量增长率与透析龄、透析前Scr、BUN、磷、β2微球蛋白、透析期间血压下降值和下降率呈正相关,其中透前BUN、Scr、磷及β2微球蛋白经残余尿量校正后,相关性无统计学意义;与年龄、干体质量、BMI、透后收缩压、平均血压及残余尿量呈负相关。 结论 本组近70%患者体质量增长率控制在5%以内。年龄小、女性、BMI低、残余尿量少、干体质量低、透析龄长、基础病因为慢性肾小球肾炎及糖尿病肾病患者在透析间期体质量增长较多。体质量增长显著影响透析期间的血压变化,应加强MHD患者透析间期的体质量增长的控制。     

高通量血液透析对维持性血液透析患者高同型半胱氨酸血症和左心室结构的影响

目的观察高通量血液透析(high-flux hemodialysis,HFHD)对维持性血液透析(maintenance hemodialysis,MHD)患者高同型半胱氨酸血症(hyperhomocysteinemia,HHcy)和左心室结构及功能的影响。方法采用前瞻性、分组对照的方法,选择2014年11月至2015年11月武警四川省总队医院血液净化中心伴有HHcy的MHD患者45例,随机分成高通透析组23例和低通透析组22例。治疗6个月后,比较分析2组患者治疗前后血浆同型半胱氨酸(homocysteine,Hcy)的变化;应用彩色多普勒超声诊断仪测定患者左心室形态结构及功能。观察并记录不良反应。结果治疗后高通透析组Hcy由(24.63±7.21)μmol/L降至(12.06±5.24)μmol/L,而低通透析组由(26.01±8.17)μmol/L降至(16.15±6.21)μmol/L;2组治疗后比较,高通透析组明显低于低通透析组,差异有统计学意义(P0.05)。治疗后高通透析组与低通透析组超声心动图比较,肺动脉根部内径[(21.5±5.3)mm比(30.6±4.8)mm]、左室舒张末内径[(54.8±6.2)mm比(61.5±4.9)mm]、左房前后径[(31.9±5.7)mm比(50.3±7.3)mm]、右室前后径[(19.8±3.7)mm比(25.4±5.4)mm]、左心室心肌重量指数[(92.1±12.6)g/m~2比(98.6±9.7)g/m~2]及左心室射血分数[(71.5±12.3)%比(53.8±14.8)%],差异均有统计学意义(P0.05);而室间隔厚度[(10.9±1.9)mm比(12.1±3.1)mm],差异无统计学意义(P0.05)。2组患者治疗期间无明显不良反应。结论 HFHD能有效清除伴有HHcy的MHD患者Hcy,改善患者左心室结构及功能,值得临床广泛使用。     

低钙透析液治疗对维持性血液透析期间高血压患者的影响

目的：观察低钙透析治疗对维持性血液透析（ MHD）期间高血压患者的影响。方法：将61例维持性血液透析期间合并高血压的患者分为两组,对照组30例,为常规钙透析液组（1.75%）；治疗组31例,为低钙透析液组（1.25%）；记录患者在透析前及透析结束并静息30 min后的血压,研究期间对透析液钙离子浓度进行监测。在研究开始前及开始后对患者透析前后血钙及血磷情况每月进行检测,观察有无严重钙磷代谢紊乱情况,研究前后检测患者透析前后甲状旁腺激素（ PTH）水平。结果：不同透析液钙离子浓度对MHD期间血压的影响：两组治疗前,其收缩压及舒张压分别比较,差异无统计学意义（P〉0.05）；经过3个月的治疗观察,治疗组与对照组治疗后收缩压比较（134±13.2 vs 150±19.5）,P〈0.05,且舒张压比较（77±15.7 vs 89±19.2）,P〈0.05,说明不同透析液钙离子浓度对MHD期间高血压具有一定的治疗作用。不同透析液钙离子浓度对钙磷及PTH水平的影响：两组治疗前,其血钙、血磷及PTH分别比较,差异无统计学意义（P〉0.05）；经过3个月的治疗观察,治疗组与对照组治疗后血钙比较（1.9±0.13 vs 1.8±0.15）,P〉0.05；血磷比较（1.92±0.89 vs 1.89±0.99）,P〉0.05；PTH比较（267±44 vs 260±53）,P〉0.05,说明不同透析液钙离子浓度对MHD期间钙磷代谢及PTH水平无明显的影响。结论：低钙透析治疗对维持性血液透析（ MHD）期间高血压具有一定的治疗作用。     

The pulmonary arterial hypertension of patients on maintained hemodialysis is positively associated with the decreased percent of CD8 T cell in the peripheral blood independently

Objective To explore the risk factors of pulmonary artery hypertension (PAH) and the its relationship with T cell subsets to provide a foundation for the prevention and treatment of PAH. Methods 154 maintained hemodialysis (MHD) patients in our dialysis center were recruited according to the criterion and divided into two groups subsequently: PAH group (pulmonary artery systolic pressure, PASP＞35 mmHg) and non-PAH group (PASP≤35 mmHg). The related clinical, biochemical and ultrasonic cardiogram data were collected and peripheral blood was acquired to detect the expressions of the surface antigen CD3, CD4, CD8 and CD69 with flow cytometry. Logistic regression analysis was used to find out the relationship between PAH and T cell subsets. Results There was no significant difference between 56 cases of PAH and 98 cases of non-PAH as regards gender, age, mean systolic and diastolic pressure, dialysis durations, morbidities of hypertension and diabetes, smoking rate, and left ventricular diameter. Compared with the non?PAH group, the PAH group demonstrated a lower percent of CD8 T cells and CD8 CD69 T cells, but a much higher left atrial diameter (LAD), Interventricular septum thickness, left ventricular posterior wall thickness, and NT?proBNP. The percentage of T cells, CD4 T cells and CD4 CD69 T cells showed no difference between the two groups. Multivariate analysis confirmed that PAH was negatively independently associated with the percentage of CD8 T cells and CD8CD69 T cells. Conclusions The decreased percentage of CD8 T cells and CD8CD69 T cells in the peripheral blood is a risk factor of PAH in maintained hemodialysis patients, and CD8 T cells may play an important role in the genesis of PAH.     

Prevalence and risk factors for pulmonary arterial hypertension in end-stage renal disease patients undergoing continuous ambulatory peritoneal dialysis

Background: Pulmonary arterial hypertension (PAH) is a major complication in renal failure patients, but very little information is available on the cardiovascular parameters in these patients. The prevalence and risk factors for PAH were systematically evaluated in patients with end-stage renal diseases (ESRD) undergoing continuous ambulatory peritoneal dialysis (CAPD). Methods: Between January 2010 and January 2014, 177 ESRD patients (85 males and 92 females) undergoing CAPD therapy were recruited. General data, biochemical parameters and echocardiographic findings were collected and PAH risk factors studied. Results: Study participants consisted of 65 patients (36.52%) with PAH (PAH group) and 112 patients without PAH (non-PAH group). The interdialytic weight gain, systolic blood pressure and diastolic blood pressure (DBP), mean arterial pressure and hypertensive nephropathy incidence in the PAH group were significantly higher than the non-PAH group (all p?p?p?p?Conclusion: We observed a high incidence of PAH in ESRD patients undergoing CAPD. Logistic regression analysis revealed that DBP, NT-proBNP, LAD, RVID, RVOTD, LVEF, TAPSE and E/E’ are high-risk factors for PAH in ESRD patients undergoing CAPD.     

法舒地尔对肺血管重构的肺动脉高压大鼠的影响

目的 观察法舒地尔对发生肺血管重构的肺动脉高压(PAH)大鼠的影响.方法 将32只雄性Wistar大鼠随机均分为4组:对照3周组,模型3、6周组及治疗组;予野百合碱建模;治疗组于3周后予法舒地尔腹腔内注射.于3、6周末测定各组大鼠右心室收缩压(RVSP)、内皮素-1(ET-1)、N端脑钠素前体(NT-proBNP)、肺小动脉病理等.结果 (1)造模后RVSP随时间升高(31.2±7.6)、(43.3±8.3)、(56.9±6.9)mm Hg(1 mm Hg=0.133 kPa),治疗组(47.3±6.3)mmHg较模型6周组明显降低.(2)ET-1、NT-proBNP与RVSP呈正相关(r=0.721、0.454).(3)病理:造模后肺动脉平滑肌增生,管壁狭窄,至6周时近于闭塞,治疗组则明显好转.结论 对于已发生肺血管重构的PAH大鼠,法舒地尔能阻止肺动脉高压进展,ET-1、NT-proBNP可成为较理想的评估指标.

Abstract：

Objective To investigate the effects of Rho kinase inhibitor fasudil on monocrotaline (MCT)-induced pulmonary arterial hypertension (PAH) with vascular remodeling in rats. Methods Thirty-two male Wistar rats were randomly and equally divided into control group ( C3 ), MCT-PAH 3- and 6-week model groups (H3, H6 ) and fasudil-treated group (F6). The right ventricle systolic pressure( RVSP), right ventricle/left ventricle and septum[RV/( LV + S)], plasma endothelin-1 and NT-proBNP were measured; small pulmonary arterial morphometry, ratio of vascular wall thickness to vascular external diameter (WT) and ratio of vascular wall area to the total area (WA) were also observed. Results ( 1 )The RVSP was highest in H6 group, followed by F6 group, H3 group, and C3 group[(56. 9 ±6. 9), (47. 3±6.3), (43.3±8.3) and (31.2±7.6) mm Hg (1 mm Hg=0. 133 kPa)]. But no significant difference was found between H3 and F6 groups; (2) The levels of plasma ET-1 and NT-proBNP were positively associated with RVSP, RV/(LV +S), WT and WA (r for ET-1 was 0.721, 0.607, 0.652, 0.707,P＜0.01; r for NT-proBNP was 0. 454, 0. 330, 0. 365, 0. 398,P ＜0. 05); (3) Pathematological assessment showed that the thickness and muscularization of small pulmonary artery were increased in H3 group as compared with C3 group, most significantly in H6 group, and those were significantly decreased in F6 group as compared with H6 group. Conclusion Fasudil can improve the MCT-induced PAH with vascular remodeling in rats. The plasma ET-1 and NT-proBNP could be used as good makers to evaluate the severity of PAH.     

波生坦治疗先天性心脏病术后肺动脉高压的前瞻性随机对照研究

目的 评价应用波生坦治疗婴幼儿先天性心脏病术后肺动脉高压的疗效.方法 30例术前合并肺动脉高压且手术治疗后仍有肺动脉高压的先大性心脏病病儿入选.所有病儿均在低温体外循环辅助下完成心内畸形根治术,术后1周行超声心动图检查,估测肺动脉收缩压＞30mm Hg者随机分配到波生坦治疗组(15例)及对照组(15例)中.研究周期12周,波生坦组:传统治疗+波生坦,波生坦给药方案:10～20 kg病儿,31.25 mg,每日1次(qd)4周,31.25 mg,每日2次(bid)8周;5～10 kg病儿,15.6 mg,qd(4周),15.6 mg,bid(8周);对照组:传统治疗(地高辛、双氢克脲塞).两组病例于术后13周接受门诊随访、调查问卷、超声检查和血液检查.比较两组心功能及临床症状,超声心动图评价血流动力学和肺动脉高压变化,以及血浆内皮素(Endothelin-1,ET-1)变化.结果 两组病例年龄、平均体重、病种分布、基线肺动脉收缩压力、基线血浆ET-1浓度均无统计学差异.心功能改善方而,依据NYHA心功能分级(级数增高定义为心功能恶化,降低则为心功能改善).波生坦治疗组93%的病儿心功能较基线水平改善Ⅰ级,无心功能恶化;对照组只有73%病儿心功能较基线水平改善Ⅰ级,13%病儿心功能较基线水平恶化Ⅰ级.将术后因心肺功能不全再入院及死亡定义为临床恶化,波生坦治疗组无再入院及死亡发生;而对照组13%的病儿发生了临床恶化(1例病儿术后11大死亡,1例病儿术后60天再入院).波生坦治疗组:基线(术后1周)肺动脉收缩压(48.5±9)mm Hg,治疗12周后(29.0±8.0)mm Hg,治疗前后差异有统计学意义(P＜0.01,95%CI:12～27);对照组:基线(术后1周)肺动脉收缩压(45.4±16)mm Hg,12周后(35.1±15.0)mm Hg手术前后差异无统计学意义(P＞0.1).两组之间比较,波生坦治疗组较对照组能更好的降低肺动脉压力(P＜0.05,95%CI:0.1～1 8.3).应用波生坦治疗后血浆ET下降(2.01±0.03)fmol/ml(1 fmol/ml=10-15mol/ml,P=0.03),对照组血浆ET升高(0.15±0.10)fmol/ml(P=0.77).波生坦组有2例肝脏转氨酶升高,停药后自然恢复正常,后未继续服药;无其他明显副作用.结论 波生坦治疗左向右分流的先天性心脏病术后残留肺动脉高压疗效明显,有助于病儿术后心功能及临床症状的恢复.     

核素肺灌注显像对瓣膜性心脏病合并肺动脉高压病人的手术疗效观察

目的 探讨采用首次通过法核素肺灌注显像、通过放射性时间-计数曲线方法了解瓣膜性心脏病合并有肺动脉高压(PH)手术前、后肺动脉压力的变化规律的价值.方法 115例二尖瓣病变为主的瓣膜性心脏病病人均行瓣膜置换或成形术治疗.所有病人在手术前,手术后7天行核素肺灌注显像检查,33例在术后3个月进行第3次复查.另选10名健康者,测其肺循环平均时间(LET)作为正常对照组.结果 与术前相比,术后7天LET明显降低(P<0.001).33例术后3个月的LET与术后7天差异虽无统计学意义,但LET仍有继续下降趋势.结论 瓣膜性心脏病合并有PH病人,肺动脉压力的降低在术后7天左右最明显,此后降低缓慢.术前肺动脉压力越高,在术后早期越难以降至正常水平.无创性核素肺灌注显像检查方法在瓣膜性心脏病合并PH的术前判定、手术疗效和预后判断等方面有明显的优点和实用价值.     

Detection of pulmonary hypertension by Doppler echocardiography of the inferior vena cava in chronic airflow obstruction.

Pulsed Doppler echocardiography of the inferior vena cava is an accurate method for the diagnosis of tricuspid regurgitation and impaired right ventricular compliance, two features of pulmonary hypertension. The purpose of this study was to assess the value of Doppler echocardiography of the inferior vena cava for the detection of pulmonary arterial hypertension in patients with chronic obstructive lung disease. Pulse Doppler echocardiography of the inferior vena cava and right heart catheterisation were performed in 29 patients with severe chronic obstructive lung disease. The mean pulmonary arterial pressure was 27 (10) mm Hg for the entire group; 62% of patients (18/29) had pulmonary arterial hypertension (mean pulmonary arterial pressure greater than 20 mm Hg). An adequate Doppler signal could be obtained in 25 of the 29 patients (86%). Pulsed Doppler echocardiography of the inferior vena cava gave normal results in 10 patients and disclosed tricuspid regurgitation in seven patients, impaired right ventricular compliance in seven patients, and both of these abnormalities in one patient. An abnormal Doppler echocardiogram of the inferior vena cava (tricuspid regurgitation or impaired right ventricular compliance, or both) predicted the presence of pulmonary arterial hypertension with a sensitivity of 87% and a specificity of 80%. These results suggest that pulsed Doppler echocardiography of the inferior vena cava may be a useful though imperfect method of detecting pulmonary arterial hypertension in patients with chronic obstructive lung disease.     

Related factors of pre-dialysis blood pressure variability in under-age patients undergoing maintenance hemodialysis

Objective To explore the blood pressure variability (BPV) in pediatric patients undergoing maintenance hemodialysis (MHD) and to assess the factors associated with pre-dialysis BPV(pre-HD BPV). Methods The pediatric patients who undergone regular dialysis for more than twelve months from Oct 2005 to Oct 2011 in hemo dialysis center of Guizhou Provincial People's Hospital were divided into high pre-HD BPV group and low pre-HD BPV group. Baseline characteristics, biochemical indexes and cardiac function parameters measured by echocardiography were collected in both groups and multiple linear regression analysis was performed. Results Pediatric patients in high pre-HD BPV group demonstrated significantly higher inter-dialytic weight growth rate (IDWG), pre-dialysis systolic blood pressure and average amount of dehydration than those in low pre-HD BPV group (P＜0.05), while significantly lower hemoglobin and albumin levels than those in low pre-HD BPV group (P＜0.05). Comparison among laboratory indicators, serum phosphorus and parathyroid hormone demonstrated significant difference between groups (P＜0.05). For all pediatric patients, pre-HD BPV was positively correlated with IDWG (β=0.165), pre-dialysis systolic blood pressure (β=0.259), and iPTH (β=0.187), while negatively correlated with hemoglobin level (β=-0.199). Conclusions Increasing IDWG, higher pre-dialysis systolic blood pressure, anemia and secondary hyperparathyroidism influence BPV in pediatric patients on MHD.     

Surgical strategy in patients with atrial septal defect and severe pulmonary hypertension

The aim of the study was to review our experience with atrial septal defect (ASD) closure with a fenestrated patch in patients with severe pulmonary hypertension. Between July 2004 and February 2009, 16 patients with isolated ASD underwent closure with a fenestrated patch. All patients had a secundum type ASD and severe pulmonary hypertension. Patients ranged in age from 6 to 57 years (mean ± SD, 34.9 ± 13.5 years). The follow-up period was 9 to 59 months (mean, 34.5 ± 13.1 months). The ranges of preoperative systolic and pulmonary arterial pressures were 63 to 119 mm Hg (mean, 83.8 ± 13.9 mm Hg) and 37 to 77 mm Hg (mean, 51.1 ± 10.1 mm Hg). The ranges of preoperative values for the ratio of the pulmonary flow to the systemic flow and for pulmonary arterial resistance were 1.1 to 2.7 (mean, 1.95 ± 0.5) and 3.9 to 16.7 Wood units (mean, 9.8 ± 2.9 Wood units), respectively. There was no early or late mortality. Tricuspid annuloplasty was performed in 14 patients (87.5%). The peak tricuspid regurgitation gradient and the ratio of the systolic pulmonary artery pressure to the systemic arterial pressure were decreased in all patients. The New York Heart Association class and the grade of tricuspid regurgitation were improved in 13 patients (81.2%) and 15 patients (93.7%), respectively. ASD closure in patients with severe pulmonary hypertension can be performed safely if we create fenestration. Tricuspid annuloplasty and a Cox maze procedure may improve the clinical result. Close observation and follow-up will be needed to validate the long-term benefits.     

风湿性心脏病二尖瓣狭窄合并肺动脉高压者血管力学特性的变化

目的　探讨风湿性心脏病(风心病)二尖瓣病变合并肺动脉高压(肺高压)的肺血管力学特性的变化规律。方法　借助右心导管技术和利用压力波形面积确定动脉顺应性的改进方法,测定肺血流动力学和肺血管顺应性。结果　①二尖瓣狭窄(MS)为主合并肺高压组的肺动脉血管零压(C