Chinese Journal of Blood Purification

Application of Left Atrial Volume Index in Hemodialysis Patients

2013, 12 (03): 126-129.

Abstract ( 444 )

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Objective To evaluate the function and structure of the heart and to investigate the relationship between left atrial volume index (LAVI) with left ventricular systolic and diastolic function, left ventricular mass index(LVMI) in hemodialysis patients. Methods One hundred and one patients on maintenance hemodialysis were recruited. Doppler echocardiogram examinations were performed by one well-trained physician in ultrasonography on interdialytic days. The following measurements were obtained: end systolic volume(ESV), end diastolic volume(EDV), ejection fraction(EF%). From the mitral inflow profile, the ratio of early (E) to late atrial (A) mitral Doppler peak flow velocity (E/A ratio) was calculated as an index of left ventficular diastolic function. LAV was calculated by the biplane method of discs at the end of left ventricle systole. LAVI and LVMI were analyzed as body surface area indexed estimates. Results The mean age was 62.6±10.8 years and median duration of hemodialysis was 52（12,218） months. The mean LAVI was 34.7±14.4ml/m2. The mean LVMI was 145.5±57.3g/m2. The mean EF was 63.3%±10.8% and the mean E/A ratio was 0.80±0.27. Augmentation in LAVI was present in 50.6% of the patients. There were statistical differences in E/A ratio and EF% between patients with LAVI > 32 ml/m2 and patients with LAVI≤ 32ml/m2. LAVI was negatively correlated with EF%（r=-0.311，p=0.033）, as well as with E/A ratio（r=-0.346，p=0.013）, and was positively correlated with duration of hemodialysis（r=0.267，p=0.042）, as well as with LVMI（r=0.319，p=0.029）, but was not correlated with age and gender. In multiple stepwise regression analysis, E/A ratio（β=-0.324，p=0.018）was identified as an independent variable for the LAVI. Conclusion Enlargement in LAVI was prevalent in hemodialysis patients. Determination of the changes in LAVI by echocardiogram is very important to evaluate left ventricular diastolic function and to predict the morbidity of cardiovascular events.

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Efficacy evaluation of continuous renal replacement therapy for patients with cardiac insufficiency in conjunction with hypotension after acute myocardial infarction

2013, 12 (03): 130-133.

Abstract ( 260 )

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Objective: The aim of this study was to evaluate the efficacy of continuous renal replacement therapy (CRRT) for patients with cardiac insufficiency in conjunction with hypotension after acute myocardial infarction (AMI). Method: We collected patients who had AMI in our hospital from June 2008 to December 2011. After primary percutaneous coronary intervention (PCI), 92 patients presented with cardiac insufficiency, hypotension, and acute left heart failure. All heart failure patients received routine internal treatment at first, and were randomly divided into two groups. One in which patients continued medications and another in which patients applied CRRT. Result: The cardiac function of 46 patients who received standard drug therapy gradually improved. However, compared with the CRRT group, the improvement was slow. In the 46 patients who received CRRT, 2 cases stopped CRRT due to progressive decrease of platelets. One patient with systolic blood pressure lower than 90 mmHg, clinical manifestations of organ hypoperfusion, poor peripheral circulation, cool clammy skin and oliguria, terminated CRRT. Vital signs of the 43 patients who underwent CRRT were stable. The symptoms of heart failure were significantly relieved. After CRRT, the serum electrolytes significantly improved. A week after, left ventricular ejection fraction (LVEF) also improved. The differences of the two groups in one month mortality, mean time with intensive care and mean hospital stay were significant. The numbers of patients with recurrent heart failure during one year follow-up were also significantly different. Conclusion: CRRT is a relatively safe and effective strategy for patients with cardiac insufficiency and hypotension after AMI.

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Application of diagonal reinforcement ultrafiltration on the maintenance hemodialysis patients cardiac function and blood pressure rhythm in effect

2013, 12 (03): 134-136. doi: 10.3969/j.issn.1671-4091.2013.03.005

Abstract ( 126 )

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【Abstract】 Objective To study the diagonal reinforcement ultrafiltration mode on maintenance hemodialysis patients cardiac function and the influence of blood pressure rhythm. Methods 100 cases of hemodialysis patients for support in accordance with the principle of randomized divided into observation
group and control group, each group of 50 cases, including the observation group take diagonal reinforcement ultrafiltration mode, the control group take the conventional linear ultrafiltration mode, each for hemodialysis 2000 cases of times, observation two groups of patients dialysis process center rate, blood pressure and low blood pressure rhythm changes occur. Results two groups of patients dialysis process center rate, blood pressure comparison were no statistical difference (P＞0.05); The observation group occur hypotension 41 cases of time (2.05%), and 278 cases of control group occur hypotension times (13.90%), two groups of comparisons significant difference (χ2=22.321,P=0.000). Conclusion the application of diagonal reinforcement ultrafiltration model for blood dialysis, there was no significant effect on heart function of patients, but can significantly reduce the incidence of hypotension dialysis process.

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Home Blood Pressure Monitoring for Managing Hypertension in Hemodialysis Patients

2013, 12 (03): 137-140. doi: 10.3969/j.issn.1671-4091.2013.03.00

Abstract ( 192 )

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Objective To evaluate the effect of home blood pressure monitoring(HBPM) in diagnosing and managing hypertension in hemodialysis patients. Methods The data of predialysis clinic blood pressure(CBP)and home blood pressure (HBP) in 101 hemodialysis patients were compared. The change in CBP and HBP before and after intervention was analyzed. Results The level of HBP was lower than CBP(140.5±13.6/76.2±12.8mmHg vs 147.1±14.6/81.5±15.9mmHg，P＜0.05).67(66.3%) patients’CBP was over 140/90mmHg.51(50.5%)patients were diagnosed with hypertension by HBPM. The levels of HBP and CBP significantly decreased after intervention(to down-requlate dry body weight and/or adjust antihypertensive drugs)(P＜0.05). Conclusions The level of HBP in hemodialysis
patients differs from CBP.These data provide support for the use of HBP monitoring for the diagnosis and management of hypertension in hemodialysis patients.

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The research of anatomic relationships between the internal jugular vein and the common carotid artery under CT scan

2013, 12 (03): 145-148.

Abstract ( 203 )

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Objective To investigate anatomic relationships between the internal jugular vein and the common carotid artery under CT enhancement scan at a different plane.Methods To collect the anatomic relationships between the internal jugular vein and the common carotid artery at the high plane（the upp-er edge of the thyroid cartilage）、median plane（the level of the cricoids ca-rtilage）in our hospital patients since January 2010 to July 2012,all patients were checked by CT enhancement scan. Results At the high plane,the internal j-ugular veins are mainly posterior and posterolateral position（78.6%-83.9%）,the relationships with the common carotid artery are mainly partially overlap（70.5%-71.4%）.While at the median plane ,the internal jugular veins are mainly anterior and anterolateral position（72.3%）,the relationships with the common carotid artery are mainly parallel（56.2%-63.4%）. Conclusion Operating the internal jugular vein cannulation at the median plane had higher success rate and reduced more complications than the high plane.

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The study of clearance effect of plasma perfusion in patients with paraquat poisoning using dual- cartridge in series

2013, 12 (03): 149-151.

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【Abstract】 Objective To study the clearance effect of plasma perfusion for the plasma paraquat (PPQ) using dual- cartridge in series and to explore the feasibility of dual-tank in series plasma perfusion in the treatment of paraquat poisoning. Methods 16PQ-poisoned Patients who arrived our poisoning Center within 24 hours after paraquat poisoning were prospectively enrolled. Bual-tank in series plasma perfusion (blood flow rate of 180 ml / min, Plasma flow 40ml / min) was performed and Activated carbon cartridge were changed every 3 hours.The concentration of PPQ was recorded in the before, during and after of the two cartridge every 3h. Results 1) The change of paraquat concentration: During the first plasma perfusion, the concentration of PPQ before, during and after the two cartridge (16 cases)were: 6.70 (6.44,4.36), 5.75 (3.65,7.53) and 4.40 (2.55,6.33); before and after the single cartridge（18 cases）were：7.25(5.28,9.15)and 5.55 (3.55,7.25). 2nd the two cartridge (16 cases) were: 4.00 (1.55,4.25), 2.70 (0.90,3.50) and 1.90 (0.35,2.85); the single cartridge（18 cases）were : 4.50(2.28,6.15)and 2.80(0.83,4.98).3rd the two cartridge (8 cases) were: 2.00 (1.03,2.70), 1.50 (0.68,2.15) and 0.95 (0.45,1.70); the single cartridge（15cases）were : 3.10(0.97,4.60)and 2.30(0.40,3.35).4th the two cartridge (6 cases) were: 1.14 ± 0.96,0.87 ± 0.78 and 0.65 ± 0.67; the single cartridge（11cases）were :1.90(0.79,3.05)and 0.90(0.45,2.40). 2) Paraquat clearance rate of each cartridge: During the first plasma perfusion, the Paraquat clearance rate of double cartridge, cartridge1and cartridge2 were: 14.36 ± 5.72,8.01 ± 4.04 and 8.49 ± 3.77; the Paraquat clearance rate of single cartridge（18cases）was : 10.37±5.67.when the second plasma perfusion, the Paraquat clearance rate of double cartridge, cartridge1and cartridge2 were : 21.53± 7.74,12.91 ± 7.76 and 16.12 ± 7.23; the single cartridgewas : 15.58±8.14. 3rd, the double cartridge, cartridge1and cartridge2 were: 18.39 (14.29,25.84), 9.26 (8.96,12.21) and 10.25 (7.38,19.00); the single cartridge was : 15.54±8.39.4th(6 cases): 19.17 (13.33,25.61), 9.35(4.42,13.14) and 13.45 (8.22,11.28); the single cartridge was:11.43(6.86,14.74). Conclusion Compared with the single cartridge plasma perfusion, dual-cartridge plasma perfusion can increase the clearance rate of plasma paraquat significantly and may be a method for the treatment of paraquat poisoning.

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