不同透析液钙浓度对维持性血液透析患者心率变异性的影响

目的观察不同钙离子浓度的透析液对血液透析患者心率变异性(heart rate variability,HRV)的影响,为透析患者选择最适透析液钙离子浓度提供依据。方法选择血钙正常的稳定的维持性血液透析患者30例,分别使用钙离子浓度1.25mmol/L(DCa1.25)、1.50mmol/L(DCa1.5)和1.75mmol/L(DCa1.75)的透析液进行血液透析12次(透析液其他成分不变),每次透析4h,分别于最后一次血液透析开始前1h记录24h动态心电图,采用全部正常窦性心搏间期的标准差(SDNN)作为HRV的指标,应用HRV分析软件进行处理,同时监测透析前、中、后血压,检测透析前后血清总钙、磷、血浆尿素氮、肌酐、血红蛋白、血浆白蛋白以及全段甲状旁腺激素等。结果采用DCa1.25血液透析时,透析后血总钙明显下降(P0.05),透析中、透析后收缩压、舒张压、平均动脉压明显下降(P0.05),透析开始后SDNN逐渐下降,至3h时与透析前相比差异有统计学意义(P0.01)。采用DCa1.5血液透析时,透析后血总钙较前升高(P0.05),透析中、透析后收缩压、舒张压、平均动脉压略降低,与透析前相比差异无统计学意义(P0.05),但SDNN表现出与上述类似的规律,即透析3h时SDNN显著下降(P0.05)。采用DCa1.75血液透析时,透析后血总钙、透析中、透析后收缩压、舒张压、平均动脉压以及透析2～3h时SDNN均明显上升,与透析前相比差异均有统计学意义(P0.05)。但三组患者的SDNN在透析结束后2h基本恢复到透析前水平。结论不同钙浓度透析液对维持性血液透析患者的HRV产生不同影响,DCa1.25、DCa1.5透析中HRV下降,DCa1.75透析中HRV增加。

Effect of different calcium concentrations in dialysate on heart rate variability in maintenance hemodialysis patients

Objective To observe the effect of different calcium concentrations in dialysate on heart rate variability （HRV） in maintenance hemodialysis （MHD） patients, and to provide the rationale for MHD patients to use appropriate calcium concentration in dialysate. Methods We observed 30 MHD patients with stable disease condi- tion and normal serum calcium in this study. Their dialysate for hemodialysis contained Ca2＋ 1.25mmol/L, 1.5mmol/ L or 1.75mmol/L. Each kind of dialysate was used for 12 sessions, and one session lasted for 4 hours. Examinations were performed at the last session using a kind of dialysate. Ambulatory electrocardiogram was recorded for 24 hours beginning from one hour before the session. Standard deviation of normal R-R interval （SDNN） was used as a marker of heart rate variability. Blood pressure, serum total calcium and phosphate, Na＋, K＋, albumin, creatinine, blood urea nitrogen （BUN）, and iPTH were measured before, during and after this session. Results After the dialysis using the dialysate containing 1.25mmol/L Ca2＋ BP and serum total Ca2＋ decreased （P〈0.05）, and SDNN decreased from the beginning of the session and became significantly less after 3 hours of the session （P 〈 0.01）, as compared with the pre-dialysis values. After the dialysis using the dialysate containing 1.5mmol/L Ca2＋, serum total Ca2＋ increased significantly （P 〈 0.05）, BP decreased but without statistical significance, as compared with the pre-dialysis values, and the change of SDNN was similar to that using dialysate containing 1.25mmol/L Caz＋. After the dialysis using the dialysate containing 1.75mmol/L Ca2＋, BP, serum total Ca2＋ and SDNN increased significantly after the dialysis for 2- 3 hours, as compared with the pre-dialysis values （P 〈 0.05）. However, SDNN returned to the pre-dialysis values 2 hours after the session, no matter what kind of Ca2＋ concentrations in dialysate was used. Conclusions Different CaZ＋concentrations in dialysate affect HRV in MHD patients. HRV decreased during the hemodialysis using Ca2＋ 1.25 and 1.5mmol/L in dialysate, but increased during the hemodialysis using Ca2＋ 1.75rnmol/L in dialysate.