维持性血液透析患者血液动力学变化及影响因素研究

目的研究不同心功能状态下维持性血液透析(maintenance hemodialysis,MHD)患者血液透析过程中血液动力学变化及其影响因素。方法用超声稀释法对中国医科大学附属第四医院肾内科2005年9月至2011年9月行MHD患者95例进行检测,包括患者动静脉内瘘(arteriovenous fistula,AVF)、血流量(Qa)和透析后不同时段的血液动力学指标:心输出量(Cardiac output,CO)、心搏出量(stroke volume,SV)、心脏指数(cardiac index,CI)、中心血容量(central blood volume,CBV)、中心血容量指数(central blood volume index,CBVI)、外周血管阻力(peripheral vascular resistance,PR)等参数。结果 95例患者收缩压(SBP)、SV、CO、CI及CBV明显下降,差异有统计学意义(P<0.01);PR增加,而舒张压(DBP)及心率的变化差异无统计学意义。根据透析后1hCI值,将患者分为3组,A组CI<2.5L/(min·m2)、B组CI2.5～4.2L/(min·m2)、C组CI>4.2L/(min·m2)。A、B组患者透析3h后SV、CO、CBV较透析1h明显下降,PR增高(P均<0.01),A组最为明显,而C组前后血液动力学指标无明显差异。结论 MHD患者血液动力学改变表现主要为血压、CO、CI以及CBV降低,PR增高。不同心功能患者血液动力学改变程度不同,CI与Qa、SBP、年龄、糖尿病有相关关系。

Hemodynamic change and its related factors in maintenance hemodialysis patients with different cardiac functions

Objective To investigate hemodynamic change during hemodialysis and its related factors in maintenance hemodialysis （MHD） patients with different cardiac indices. Methods Seventy-five patients with arteriovenous fistula （AVF） for blood access were enrolled in this study. Cardiac output （CO）, stroke volume （SV）, cardiac index （CI）, central blood volume （CBV） and peripheral vascular resistance （PR） were determined by ultrasound dilution technique at the end of first hour, second hour and third hour during dialysis. AVF blood flow （Qa） was also measured with the same device before the measurement of hemodynamic parameters. Results Systolic arterial pressure, SV, CO, CI and CBV were significantly decreased （P〈0.01） but without changes in diastolic arterial pressure and heart rate at the end of second hour and third hour during hemodialysis. PR increased gradually during hemodialysis. After dialysis for one hour, patients were divided into three groups： group A （CI 〈2.5 L/rain/m2）, group B （CI =2.5 ~4.2 L/rain/m2）, and group C （CI 〉4.2 L/rain/ m2）. In groups A and B, SV, CO, and CBV were lower and PR was higher after dialysis for 3 hours, as com- pared with those parameters after dialysis for one hour （P〈0.01）. Additionally, these changes were more evi- dent in group A than in group B （P〈0.01）. In group C, however, these hemodynamic parameters were indiffer- ent before and after dialysis. CI value correlated positively with Qa and systolic arterial pressure, and nega- tively with age and diabetes. Conclusions Systolic arterial pressure, CO, CI, and CBV decreased and PR increased during hemodialysis in MHD patients. These changes were more evident in patients with CI 〈2.5 L/ mira/m2. CI correlated positively with Qa and systolic arterial pressure, and negatively with age and diabetes.