维持性血液透析对尿毒症患者左心室收缩和舒张功能的影响及其相关因素分析

目的应用多普勒超声心动图检测维持性血液透析患者左心室收缩及舒张功能指标,并探讨相关因素对心脏功能的影响。方法根据血压、血红蛋白、每周透析时间和KT/V值将44例尿毒症患者分为透析充分组(A组,24例)和未充分透析组(B组,17例)。血液透析前后及首次超声心动检查一年后透析前测定左房内径(LAD)、左室舒张末内径(LVDd)、左室收缩末内径(LVDs)、室间隔厚度(IVST)、左室后壁厚度(LVPWT),得出左室射血分数(EF)、左室短轴缩短率(FS),测定心率(HR)。并依据上述指标判断左心室收缩及舒张功能。结果首次超声心动检查左心室舒张功能减退占59.1%,收缩功能减退占18.2%;左心室肥厚占43.2%。LAD、LVDd、LVDs、IVST、LVPWT值较对照组明显增加,FS、EF、E/A、EI/AI较对照组明显降低,单次透析前后FS、EF、E/A、EI/AI无显著变化。一年后左心室舒张功能减退占80.5%;收缩功能减退占22.0%,均同时伴有舒张功能减退。左心室肥厚占70.7%。LAD、LVDd、LVDs、IVST、LVPWT值明显增加,FS、EF、E/A、EI/AI明显降低;A、B组LAD、LVDd、LVDs、IVST、LVPWT均较对照组明显增加,B组尤为显著;B组E/A、EI/AI较A组明显下降。结论长期维持性血液透析患者首先出现左心室舒张功能障碍,进而影响收缩功能;单次血液透析后左心室收缩及舒张功能无改善;血液透析一年后左心室收缩、舒张功能明显降低,尤以舒张功能降低显著。未充分透析患者舒张功能下降更明显。

The analysis of effect and the correlative factors of maintenance hemodialysis on left ventricular contract and diastolic function in the urimia patients

Objective To examine left ventricular contract and diastolic functions by color Doppler echocardiography in maintenance hemodialysis patients,and to explore the effect of correlation factors on left ventricular function.Methods The LADLVAdLVDsIVSTLVPWTEFFSHR values were measured for 44 patients in prepost-dialysis and one year later,and the left ventricular contract and diastolic function were estimated.The patients were divided into two groups, sufficient dialysis group and non sufficient dialysis group, according to,blood presure,Hgb,hemodialysis time per week and KT/V. Results In first echocardiography examination,59.1% patients',left ventricular diastolic function were decreased,18.2% left ventricular contract function decreased,43.2% patients',left ventricle were fleshy,the values of LADLVDdLVDsIVST LVPWT significantly increased,FSEFE/AEI/AI significantly decreased;There were no obviously changes in these value after single dialysis.One year later,80.5% patients',left ventricular diastolic function decreased,22.0% left ventricular contract function decreased,70.7% patients',left ventricle were fleshy,the value of LADLVDdLVDsIVST LVPWT significantly y increased,FSEFE/AEI/AI significantly decreased,especially in non sufficient dialysis group.The values of E/AEI/AI in non sufficient dialysis group were significantly lower than sufficient dialysis group.Conclusion The first appearance was letdown for left ventricular diastolic function,and then to contract fonction.There was no change of the functions after single dialysis.One year later left ventricular contract and diastolic function distinctly decreased.The heart funtions obviously decreased in all patients no matter sufficient dialysis or not,especially for the diastolic function in non sufficient dialysis patients.