慢性肾衰血液透析患者心率变异性及其影响因素分析

目的 :分析慢性血液透析患者的心率变异性 （HRV）及其影响因素。方法 :观察了 80例接受慢性血液透析治疗的患者。血液透析开始前记录 2 4h动态心电图 ,采用 R- R间期的标准差 （SDNN）作为 HRV的指标。采用多元回归法 ,对年龄、性别、透析前体重指数、缺血性心肌病、糖尿病肾病、吸烟、累积进行血液透析的时间、透析前平均血压、血细胞比容 （Hct）、血浆尿素氮水平 （BU N）、转换酶抑制剂 （ACEI）和β-受体阻滞剂的使用等 12个可能影响 SDNN的独立因素进行了分析。结果 :老年 （P<0 .0 1） ,原发病为糖尿病肾病 （P<0 .0 1） ,Hct降低 （P=0 .0 12 2 ） ,透析前体重指数增加 （P=0 .0 132 ） ,长期进行血透的患者 （P=0 .0 2 0 1）及吸烟者 （P=0 .0 34 5 ）与 SDNN的降低呈明显的相关性。结论 :除已证明的因素外 ,慢性血液透析患者的肾性贫血、透析前体重指数及累计进行血液透析的时间也是患者心率变异性的独立影响因素

Determinants of heart rate variability in chronic hemodialysis patients

AIM: To clarify determinants of heart rate variability in hemodialysis patients, METHODS: We evaluated 80 patients receiving chronic hemodialysis.Ambulatory electro cardiogram was recorded for 24 h from the beginning of hemodialysis. Standard deviation of the normal R R interval (SDNN) was used as a marker of heart rate variability. Multiple regression analysis was performed to select independent variables associated with SDNN from the following 12 variables: age, sex, body mass index before hemodialysis, presence of ischemic heart disease, diabetic nephropathy as primary renal disease, smoking, duration of hemodialysis, mean blood pressure before hemodialysis, use of beta blockers, use of angiotensin converting enzyme inhibitors, hematocrit, and blood urea nitrogen. RESULTS: Older age( P <0.01), presence of diabetic nephropathy as primary renal disease ( P <0.01), lower hematocrit ( P =0.0122), larger body mass index before hemodialysis ( P =0.0132), longer duration of hemodialysis ( P =0.0201), and smoking ( P =0.0345) were associated with reduced SDNN. CONCLUSION:In hemodialysis patients, SDNN as a marker of cardiac autonomic modulation was associated with hematocrit, body mass index, and duration of hemodialysis, in addition to previously reported variables.