血液透析频率对终末期肾病患者心率变异性的影响

目的 探讨终末期肾病患者不同血液透析频率对心率变异性(HRV)的影响及血液透析前后心率变异性的变化. 方法 收集规律透析患者107例,根据透析频率将患者分为1次/2d(Q2d组,共40例)、1次/3d(Q3d组,共37例)及1次/4d(Q4d组,共30例),3组患者透析前后各HRV指标并进行对比分析.结果 3组患者透析后各HRV指标均出现升高,以Q2d组及Q3d组升高明显[Q2d:相邻RR间期相差＞50ms的个数占总心跳次数的百分比(PNN50)7.01±3.21比6.19±2.56 P＜0.05,24h,全部正常RR间期的标准差(SDNN) 135.11±21.98比105.29±20.78P＜0.01,相邻RR间期差值均方的平方根(RMSSD)80.78±17.96比67.66±16.87 P＜0.01, 24h内每5min的RR间期平均值的标准差119.22±23.41比108.32±21.20P＜0.05,全部相邻RR间期之差的标准差(5DSD)77.38±17.78比68.29±18.48P＜0.05]; Q3d:SDNN 128.65±23.79比101.32±19.88P＜0.01,RMSSD74.69±16.56比65.36±15.19 P＜0.05,SDANN 116.33±21.01比105.54±21.07P＜0.05,SDSD 73.19±17.33比65.17±16.08 P＜0.05; Q4d:SDNN 107.16±20.04比90.86±19.54 P＜0.05,RMSSD 66.74±17.82比58.63±15.88P＜0.05),透析前、后3组患者间的方差分析结果显示组间的差别有统计学意义(透析前:PNN50、SDNN、RMSSD、SDANN、SDSD的F值分别为2.96、3.65、3.09、3.34、2.90,P＜0.05;透析后:PNN50、SDNN、RMSSD、SDANN、SDSD的F值分别为2.96、3.65、3.09、3.34、2.90,P＜0.05),且随着透析次数减少HRV有降低趋势. 结论 长期充分的血液透析可能有助于心脏自主神经功能的改善.

Impact of hemodialysis frequency on heart rate variability in patients with end stage of renal disease

Aims To explore the impact of hemodialysis and hemodialysis frequency on heart rate variability (HRV) in patients with end stage renal disease. Methods A total of 107 patients treated with regular hemodialysis were enrolled in this study. They were assigned into 3 groups according to the hemodialysis frequency: Q2d group (once every 2 days), Q3d group (once every 3 days) and Q4d group (once every 4 days). The parameters of HRV were compared between the 3 groups. Results The parameters of HRV were increase after hemodialysis in all patients, especially higher in Q2d and Q3d group (Q2d:PNN50 7.01±3.21 vs 6.19±2.56 P<0.05,SDNN 135.11±21.98 vs 105.29±20.78 P<0.01, RMSSD 80.78±17.96 vs 67.66±16.87 P<0.01,SDANN 119.22±23.41 vs 108.32±21.20 P<0.05,SDSD 77.38±17.78 vs 68.29±18.48 P<0.05;Q3d:SDNN 128.65±23.79 vs 101.32±19.88 P<0.01,RMSSD 74.69±16.56 vs 65.36±15.19 P<0.05,SDANN 116.33±21.01 vs 105.54±21.07 P<0.05,SDSD 73.19±17.33 vs 65.17±16.08 P<0.05;Q4d:SDNN 107.16±20.04 vs 90.86±19.54 P<0.05, RMSSD 66.74±17.82 vs 58.63±15.88 P<0.05). A means of analysis of variance model showed that there is a significant deference between the 3 groups in before and after hemodialysis (Before:F value of PNN50, SDNN, RMSSD, SDANN and SDSD were 2.96, 3.65, 3.09, 3.34 and 2.90,P<0.05;After:F value of PNN50, SDNN, RMSSD, SDANN and SDSD were 2.96, 3.65, 3.09, 3.34 and 2.90,P<0.05). HRV has been trending down with the reduce of hemodialysis. Conclusions Long term and adequate hemodialysis may be useful for the improvement of heart autonomic function.