动静脉内瘘对维持性血液透析患者左心室结构及功能的影响

目的：探讨动静脉内瘘对维持性血液透析（血透）患者左心室结构及功能的影响。方法：观察44例血透患者治疗前及治疗后12个月、24个月时的血红蛋白水平、透析间期体重增长量、血压、内瘘吻合口直径、血流量、左心室结构及功能等指标。第24个月根据患者内瘘血流量的大小分为低血流量组（A组＜900ml/min)及高血流量组（B组≥900ml/min)。结论：随血透时间的延长，左心室舒张末内径（LVDd)、室间隔厚度（IVST）及左心室心肌重量指数（LVMI）逐渐增大，心胸比例提高，以血透治疗后24个月高血流量组（B组）显著，左心收缩及舒张功能以射血分数（EF）及舒张早期及晚期最大血流速度比（E／A）变化明显。A、B两组重度水钠潴留者的心胸比例、LVDd及LVMI高于同组的轻度水钠潴留者，E／A低于轻度水钠潴留者。相关分析提示，内瘘血流量与LVDd、LVMI呈明显正相关（均P＜0．05），与EF及E／A呈负相关（P＜0．05），而在左心室收缩末内径（LVDs)、短轴缩短率（FS）及等容舒张时间（IRF）无显著相关性。结论：较高的内瘘血流量与左心室结构及功能的变化有关，水钠潴留有协同作用。

Effects of arteriovenous fistula on structure and function of left ventricle in patients with maintained hemodialysis

Objective To investigate the effects of arteriovenous fistula on structure and function of left ventricle in patients with maintained hemodialysis. Methods Levels of hemoglobin, inter-hemodialysis weight increase, blood pressure, diameter and blood flow of the fistula, structure and function of left ventricle were examined before and 12, 24 months after hemodialysis treatment in 44 patients who were divided into group A(low flow group, < 900 ml/min) and group B(high flow group, > 900 ml/min) based on the fistula flow at the 24th month. Results Left ventricular end-diastolic diameter (LVDd), interventriculare septal thickness (IVST) and left ventricular mass index (LVMI) increased gradually as the time of hemodialysis going on. The cardio-cheat proportion also increased as well as ejection fraction (EF) and the peak velocity ratio of early and late diastolic period(E/A), especially significantly increased in group B. Cardio-chest proportion , LVDd and LVMI were higher and E/A lower in patients with severe sodium retention than those with mild sodium retention in both groups. The fistula flow was positively related to LVDd and LVMI( P < 0. 05) and negatively to EF and E/A( P < 0. 05) significantly, while not to the left ventricular end-systolic diameter(LVDs) and isovolumic relaxation time (IRT). Conclusion Higher blood flow of fistula is related to the change of structure and function of left ventricle, meanwhile sodium retention has a synergistic action.