腹膜透析对尿毒症患者QT离散度的影响

目的探讨持续不卧床腹膜透析对尿毒症患者QT离散度的影响,并分析导致QT离散度延长的原因。方法:以首次进入透析并进行标准、规则腹膜透析六个月的患者为研究对象,共28例。于透析前后检测血清钾、镁、钙、磷、肌酐、尿素氮以及血HCO3-,血浆白蛋白等,做心脏彩超检查,测算出左心室重量指数;做标准十二导联心电图检查,测出QT离散度(QTd)及校正的QT离散度(QTcd),并对结果进行统计学分析。结果经过透析后,患者血清钾、磷、镁、肌酐和尿素氮水平均较透析前明显降低,具有显著意义。血钙、HCO3-较前升高,也具有显著意义。左心室重量指数较前增加,但差异无显著性,QTd较前延长,无显著意义,QTcd较前延长,有显著差异。对透析前数据进行多元相关分析显示:透析前尿毒症患者QT离散度的增加与左心室重量指数和血清肌酐水平呈显著正相关,而与血钙水平呈显著负相关。透析后患者QT离散度的增加与左心室重量指数和血清肌酐水平呈显著正相关。结论腹膜透析可能导致QT离散度延长,出现这种结果的原因与透析使左心室肥厚进一步加重有密切关系,而且本研究还发现透析后尿毒症状态改善的程度对QT离散度也有显著影响。

The effect of CAPD on QT dispersion in chronic renal failure patients

Objective To investigate the effect of continuous ambulatory peritonealdialysis (CAPD) on QT dispersion in end-stage renal disease patients. Method Twenty-eightCAPD patients who initiated dialysis and completed a six months regular standard CAPDprogram were enrolled in this study. Pre-dialysis examinations including serum potassium,calcium, magnesium, phosphorus, BUN, creatinine, serum albumin and HCO3- were detected andstandard 12-lead electrocardiogram was performed to determine the QT dispersion andcorrected QT dispersion (QTcd). Echocardiographic examination was done in all patients, andthe left ventricular mass index was determined by calculation. And than, all aboveprocedure were repeated after six months dialysis. Result After a six months regularstandard CAPD program, the potassium, phosphorus, magnesium, BUN and creatinine leveldecreased significantly; the serum calcium and HCO3- increased significantly. The leftventricular mass index and QTd also increased compared to pre-dialysis data, but there wasno significant difference. But the QTcd increased significantly. A multi-correlated analy-sis to pre-dialysis data indicated: the gain of QT dispersion pre-dialysis was positivelycorrelated with serum creatinine level and left ventricular mass index, but negativelycorrelated with serum calcium level. Another multi-correlated analysis to post-dialysisdata indicated: the gain of QT dispersion post-dialysis was positively correlated withserum creatinine level and left ventricular mass index. Conclusion peritoneal dialysis mayincrease QT dispersion, it is strongly correlated with the gain of left ventricular massindex. This study confirm that the QT dispersion of peritoneal dialysis patients could beinfluenced by uremic status.