中国血液净化

中国血液净化 ›› 2013, Vol. 12 ›› Issue (05): 254-258.doi: 10.3969/j.issn.1671-4091.2013.05.00

• 临床研究 • 上一篇    下一篇

维持性血液透析患者血液动力学变化及影响因素研究

王宗谦   

  1. 中国医科大学附属第四医院肾内科
  • 收稿日期:2013-01-29 修回日期:2013-03-22 出版日期:2013-05-12 发布日期:2013-07-01
  • 通讯作者: 王宗谦 E-mail:blackpet@126.com

Maintained Haemodynamic change and associated factors analysis in maintenance hemodialysis patients with different cardiac function

  • Received:2013-01-29 Revised:2013-03-22 Online:2013-05-12 Published:2013-07-01

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摘要： 摘要 目的 研究不同心功能状态下维持性血液透析（MHD）患者血液透析过程中血液动力学变化及其影响因素。 方法 用超声稀释法对XX医院肾内科2005年9月至2011年9月行MHD患者95例进行检测，包括患者动静脉内瘘(AVF)血流量（Qa）和透析后不同时段的血液动力学指标：心输出量（CO）、心搏出量（SV）、心脏指数（CI）、中心血容量（CBV）、中心血容量指数（CBVI）、外周血管阻力（PR）等参数。结果 95例患者收缩压（SBP）、SV、CO、CI及CBV明显下降，差异有统计学意义（P4.2 L/(min?m2)。A、B组患者透析3 h 后SV、CO、CBV较透析1h明显下降，PR增高（P均<0.01），A组最为明显，而C组前后血液动力学指标无明显差异。 结论 MHD患者血液动力学改变表现主要为血压、CO、CI以及CBV降低，PR增高。不同心功能患者血液动力学改变程度不同，CI与Qa、SBP、年龄、糖尿病有相关关系。

关键词: 维持性血液透析, 心功能, 血液动力学

Abstract: Abstract Objective To investigate maintained haemodynamic change during hemodialysis and analyze effects of cardiac index (CI) on hemodynamic parameters and associated influencing factors in maintenance hemodialysis(MHD) patients. Methods Seventy-five patients bearing an arteriovenous fistula (AVF) entered the study. Cardiac output (CO), cardiac index (CI), central blood volume (CBV) and peripheral vascular resistance (PR) were determined by ultrasound dilution technique at the end of 1 hour, 2 hours and 3 hours of dialysis. AVF blood flow (Qa) was also measured with the same device before maintained haemodynamic parameters investigation. Results Systolic arterial pressure, SV, CO, CI and CBV were significantly declined and no significant change for diastolic arterial pressure and heart rates at the end of 2 hour and 3 hour hemodialysis, whereas PR was increased gradually during hemodialysis. Patients were divided into there groups with CI less than 2.5 L/min?m2, 2.5-4.2 L/ min?m2 and more than 4.2 L L/ min?m2 at the end of 1 hour dialysis. Statistically significant decreasing SV, CO and increasing PR were detected in patients with CI4.2 L/min?m2 group (P4.2 L/min?m2 group. Some factors were found to be associated to CI values. Qa and systolic arterial pressure had positive relationship with CI, while age and diabetes had negative relationship with CI. Conclusions Systolic arterial pressure, CO, CI and CBV decrease and PR increases during hemodialysis. Obvious change occurs when CI is less than 2.5 L/min?m2. CI is associated with Qa, systolic arterial pressure, age and diabetes.

Key words: Hemodialysis, Hemodynamics, Cardiac index