腹膜透析患者肠系膜上动脉血流动力学改变及其与腹膜超滤功能的相关性

目的 彩色多普勒超声评价腹膜透析患者肠系膜上动脉血流动力学改变,探讨其与腹膜超滤功能的相关性.方法 应用Philips飞凡型彩色多普勒诊断仪对40例尿毒症腹膜透析患者(按透析时间分为两组,BⅠ组透析时间＜1年,BⅡ组透析时间≥1年)及20例尿毒症非透析患者(A组)肠系膜上动脉血流动力学参数进行测定.结果 (1)三组管径(D)、收缩期峰值速度(PSV)无统计学差异(P>0.05).BⅡ组舒张末期速度(EDV)、时间平均速度(TAVM)、血流量(Q)较A组及BⅠ组均明显增高(P<0.01),阻力指数(RI)、搏动指数(PI),BⅡ较A组及BⅠ组明显降低(P<0.01),而A组与BⅠ组上述参数均无统计学差异(P>0.05).(2)腹膜超滤量BⅡ较BⅠ组明显降低,差异有统计学意义(P<0.01).(3)BⅠ、BⅡ两组患者RI、PI与透析时间呈负相关(r=-0.89,P<0.01,r=-0.436,P<0.01 ),腹膜超滤量与透析时间呈负相关(r=-0.599,P<0.01);腹膜超滤量与RI、PI呈正相关(r=0.677、P<0.01,r=0.554、P<0.01).结论 彩色多普勒超声可以无创地评价尿毒症腹膜透析患者肠系膜上动脉血流动力学改变,进而了解腹膜透析对腹膜功能的影响,其中RI、PI的下降对腹膜超滤功能的损害有重要的提示意义.

Hemodynamic Changes of Superior Mesenteric Artery duringPeritoneal Dialysis and Their Relationship with Peritoneal Ultrafiltration Function

Objective To investigate the hemodynamic changes of superior mesenteric artery(SMA)during peritoneal dialysis(PD)and their relationship with peritoneal ultrafiltration function.Methods Color Doppler was used to examine SMA hemodynamic parameters in 60 subjects,which were divided into 3 groups.Group A contained 20 uremic patients without PD.Group BⅠ contained 20 patients with PD and the time of PD was less than one year.Group BⅡcontained 20 patients with PD and the time of PD was more than one year.Results (1)There were no difference in the peak systolic velocity(PSV)and diameter(D)among the three groups(P>0.05).The end-diastolic velocity(EDV),time-averaged velocity(TAVM)and blood flow(Q)were higher in group BⅡ than those in group BⅠand group A(P<0.01).But there were no differences on EDV,TAVM and Q between group A and group BⅠ(P>0.05).The Resistance index (RI) and Pulsatility index (PI) decreased in group BⅡcompared with group BⅠ and group A(P<0.01).There were no differences between group BⅠ and group A(P>0.05).(2)The peritoneal ultrafiltration volume was lower in group BⅡvs group BⅠ(P<0.01).(3)PI,RI and peritoneal ultrafiltration volume decreased along with the time of PD,and correlated negatively with PD time(r=-0.89,P<0.01,r=-0.436,P<0.01,r=-0.599,P<0.01)although the peritoneal ultrafiltration volume was correlated positively with RI,PI(r=0.677,P<0.01,r=0.554,P<0.01).Conclusions Peritoneal dialysis causes SMA hemodynamic changes.Color Doppler ultrasound can evaluate those changes non-invasively,and the decrease of RI,PI can intimate the damage of peritoneal ultrafiltration function.