中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (05): 299-303.doi: 10.3969/j.issn.1671-4091.2016.05.011

• 临床研究 • 上一篇    下一篇

透析液钾浓度对P波最大时限与P波离散度的影响

张雪蕾1,沈洋2,孙芳2,周亦伦2   

  1. 1. 北京市大兴区人民医院肾内科(张雪蕾与沈洋为共同第一作者)
    2. 首都医科大学附属北京朝阳医院肾内科
  • 收稿日期:2015-08-24 修回日期:2016-01-19 出版日期:2016-05-12 发布日期:2016-05-19
  • 通讯作者: 周亦伦 zhouyilun2008@aliyun.com E-mail:zhouyilun2008@aliyun.com
  • 基金资助:

    北京市卫生系统高层次卫生技术人才培养学科骨干（2014-3-021）

Impact of potassium concentration in dialysate on maximum P wave duration and P wave dispersion

  • Received:2015-08-24 Revised:2016-01-19 Online:2016-05-12 Published:2016-05-19

RichHTML

0

PDF

282

摘要： 目的血液透析(hemodialysis，HD)患者的房颤发病率远高于普通人群且影响HD 患者的生存率。心电图指标P 波最大时限(Pmax)与P 波离散度(P wave dispersion，Pd)是预测心房纤颤的可靠性指标。透析中的血钾迅速下降可能是诱发房颤危险因素之一，本研究旨在探讨透析液钾离子浓度对HD患者Pmax、Pd 的影响。方法采用自身前后对照的研究方法，选择2014 年11 月～2015 年1 月期间于北京朝阳医院血液净化科行规律透析的窦性心律患者117 例。于研究第1 周的周中透析应用钾浓度2.5mmol/L 透析液(DK 2.5)，第2 周周中透析应用钾浓度3.0mmol/L 透析液(DK 3.0)，余各次依旧使用钾浓度2.5mmol/L 透析液。DK 2.5 与DK3.0 透析前、后分别测量患者血压、心率并记录12 导联同步心电图。记录两次透析时的超滤量，留取透析前、后的血液样本以测定血肌酐、尿素氮与血清电解质水平。结果117 例HD 患者中男性58 例，女性59 例，平均年龄56.7±12.2(25～75)岁，平均透析龄77.3±53.6月。2 次透析相比，超滤量、透析前后的血压及心率差异无统计学意义。DK 3.0 与DK 2.5 透析前各生化指标间没有显著差异，仅DK3.0 透析后血钾高于DK2.5[(4.0±0.4)mmol/L 比(3.7±0.3)mmol/L，t=10.159，
P＜0.001]。透析后均可见Pmax 延长、Pd 增加。DK3.0 透析后Pmax 小于DK 2.5 透析后Pmax[(115.8±10.7)ms 比(121.1±11.6)ms，t =-6.215，P＜0.001]、Pd 亦然[(40.4±9.7)ms 比(46.2±10.3)ms，t=-5.989，P＜0.001]。DK 2.5 和DK 3.0 的透析前后血钾变化与单次透析前后Pmax 变化间无线性关联(DK2.5:r=0.116，P=0.213；DK 3.0，r=0.151，P=0.585)，与单次透析前后Pd 变化间亦无线性相关(DK 2.5:r=0.163，P=0.079；DK3.0,r=0.166,P=0.074)。结论提高透析液钾离子浓度可以减轻透析后Pmax、Pd 的延长，长期应用钾离子浓度3.0mmol/L 透析液可否减少HD 患者心房纤颤的发病还有待进一步研究。

关键词: P波最大时限, P波离散度, 透析液钾浓度, 血液透析, 心房纤颤

Abstract: Objective The aim of this study was to investigate the impact of potassium concentration in dialysate on maximum P wave duration (Pmax) and P wave dispersion (Pd). Methods A total of 117 maintenance hemodialysisi (MHD) patients with sinus rhythm and treated in the period from Nov. 2014 to Jan. 2015
were enrolled in this self-controlled study. Dialysate containing 2.5 mmol/L K+ (DK2.5) was used in the first week, and dialysate containing 3.0 mmol/L K+ (DK3.0) was used in the next week, followed by DK2.5 thereafter. Ultrafiltration volume in a dialysis session, serum creatinine, BUN, electrolytes, blood pressure, heart rate, and twelve-lead electrocardiogram were measured at the beginning of study, after DK2.5 for a week, and after DK3.0 for a week. Results In the 117 MHD patients (58 males, average age 56.7 years, and median MHD duration 77.3 months), ultrafiltration volume, blood pressure and heart rate were statistically unchanged between dialysis sessions. Biochemistry parameters before dialysis were similar after DK2.5 period and after DK3.0 period. Serum potassium increased (4.0 ± 0.4mmol/L vs. 3.7 ± 0.3mmol/L, t=10.159, P＜0.001) after DK3.0 for a week. Pmax and Pd were prolonged after dialysis. Pmax and Pd after DK3.0 period were shorter than those after DK2.5 period (for Pmax, 115.8±10.7 ms vs. 121.1±11.6 ms, t=-6.215, P＜0.001; for Pd, 40.4± 9.7 ms vs. 46.2±10.3 ms, t=-5.989, P＜0.001). Changes of serum potassium (ΔK+) had no linear relationship with the changes of Pmax (ΔPmax) before and after a dialysis session during the DK2.5 and DK3.0 periods, nor with the changes of Pd (ΔPd). Conclusion Higher potassium concentration (DK3.0) in dialysate can alleviate
the prolonged Pmax and Pd after hemodialysis. However, whether long-term DK3.0 can reduce the incidence of atrial fibrillation in MHD patients remains to be studied.

Key words: maximum P wave duration, P wave dispersion, dialysate potassium concentration, hemodialysis, atiral fibrillation