超声心动图评价血液透析患者左心功能的价值
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摘要
目的探讨超声心动图在血液透析患者左心功能评价中的应用价值。方法收集2016年5月至2018年12月深圳市宝安区福永人民医院收治的164例行透析治疗的尿毒症患者的临床资料,于透析前和透析后6个月行超声心动图检查,测定患者的左房内径(LAD)、左室舒张末期内径(LVDD)、左室收缩末期内径(LVDS)、左室后壁厚度(LVPW)、室间隔厚度(ISV),计算左室射血分数(LVEF)、左室缩短分数(FS)、每搏量(SV)、心排出量(CO)、E峰、A峰及E/A,比较透析前后尿毒症患者左心功能变化。结果透析前后患者的IVS [(11.4±0.3) mm vs (10.2±0.2) mm]、LVPW [(11.3±0.4) mm vs (10.6±0.3) mm]、LVDD [(53.3±2.4) mm vs (52.7±2.1) mm]和LVDS [(41.5±2.0) mm vs (40.8±1.9) mm]比较,透析后较透析前明显缩小,差异均有统计学意义(P<0.05),而透析前后的LAD [(37.1±1.9) mm vs(36.8±1.6) mm]比较差异无统计学意义(P>0.05);与透析前相比,透析后患者的LVEF和FS均有显著升高[(57.3±8.1)%vs (63.5±8.6)%,(34.2±4.6)%vs (37.8±5.7)%],差异有统计学意义(P<0.05),而反映舒张功能的指标改善不明显,透析前后比较差异无统计学意义(P>0.05)。结论超声心动图有助于早期了解尿毒症患者心脏损伤程度,并能评价血液透析后的心脏功能恢复情况。
Objective To investigate the value of echocardiography in evaluating left ventricular function in hemodialysis patients. Methods The clinical data of 164 uremic patients treated with dialysis in Fuyong People's Hospital of Baoan District of shenzhen from May 2016 to December 2018 were collected to perform the prospective study.Echocardiography was performed before and 6 months after dialysis to determine the left atrial diameter(LAD), left ventricular end-diastolic diameter(LVDD), left ventricular end-systolic dimension(LVDS), left ventricular posterior wall thickness(LVPW), and interventricular septum thickness(ISV). left-ventricular ejection fraction(LVEF), left ventricular fraction(FS), stroke volume(SV), cardiac output(CO), E peak, A peak, and E/A were calculated. Left ventricular function changes in uremic patients before and after hemodialysis were compared. Results Compared with pre-dialysis,ISV, LVPW, LVDD and LVDS decreased significantly after dialysis:(11.4±0.3) mm vs(10.2±0.2) mm,(11.3±0.4) mm vs(10.6±0.3) mm,(53.3±2.4) mm vs(52.7±2.1) mm,(41.5±2.0) mm vs(40.8±1.9) mm, all P<0.05; there was no significant difference in LAD between pre-dialysis and post-dialysis:(37.1±1.9) mm vs(36.8±1.6) mm), P>0.05; the levels of LVEF and FS in post-dialysis patients increased significantly:(57.3±8.1)% vs(63.5±8.6)%,(34.2±4.6)% vs(37.8±5.7)%, all P<0.05; there was no significant difference in the improvement of diastolic function(P>0.05). Conclusion Echocardiography is helpful to early understand the degree of cardiac injury in uremic patients and to evaluate the recovery of cardiac function after hemodialysis.
Objective To investigate the value of echocardiography in evaluating left ventricular function in hemodialysis patients. Methods The clinical data of 164 uremic patients treated with dialysis in Fuyong People's Hospital of Baoan District of shenzhen from May 2016 to December 2018 were collected to perform the prospective study.Echocardiography was performed before and 6 months after dialysis to determine the left atrial diameter(LAD), left ventricular end-diastolic diameter(LVDD), left ventricular end-systolic dimension(LVDS), left ventricular posterior wall thickness(LVPW), and interventricular septum thickness(ISV). left-ventricular ejection fraction(LVEF), left ventricular fraction(FS), stroke volume(SV), cardiac output(CO), E peak, A peak, and E/A were calculated. Left ventricular function changes in uremic patients before and after hemodialysis were compared. Results Compared with pre-dialysis,ISV, LVPW, LVDD and LVDS decreased significantly after dialysis:(11.4±0.3) mm vs(10.2±0.2) mm,(11.3±0.4) mm vs(10.6±0.3) mm,(53.3±2.4) mm vs(52.7±2.1) mm,(41.5±2.0) mm vs(40.8±1.9) mm, all P<0.05; there was no significant difference in LAD between pre-dialysis and post-dialysis:(37.1±1.9) mm vs(36.8±1.6) mm), P>0.05; the levels of LVEF and FS in post-dialysis patients increased significantly:(57.3±8.1)% vs(63.5±8.6)%,(34.2±4.6)% vs(37.8±5.7)%, all P<0.05; there was no significant difference in the improvement of diastolic function(P>0.05). Conclusion Echocardiography is helpful to early understand the degree of cardiac injury in uremic patients and to evaluate the recovery of cardiac function after hemodialysis.
引文
[1]刘武岩,孙建新,齐卡,等.超声心动图评价肾移植术前不同血液透析时间对尿毒症患者心脏结构和功能的影响[J].中华医学超声杂志(电子版), 2013, 4:313-317.
[2]胡科丹,邹懿,宋萍,等.三维整体面积应变评价血液透析患者左心功能的研究[J].临床超声医学杂志, 2016, 18(7):448-451.
[3]李爱莉,柯元南,曾玉杰,等.尿毒症维持性血液透析患者左心室构型和功能的超声心动图研究[J].中华心血管病杂志, 2009, 37(10):913-916.
[4]郭佳妮.超声心动图对尿毒症血透患者在透析前后心脏结构与功能改变的研究[J].罕少疾病杂志, 2017, 24(2):35-37.
[5]邓晓莉,冀建峰,刘蓓,等.超声心动图检测尿毒症患者血液透析前后心功能变化[J].心脏杂志, 2016, 28(1):33-34, 37.
[6] NAPORA M, GRACZYKOWSKA A, et al. Relationship between serum asymmetric dimethylarginine and left ventricular structure and function in patients with endstage renal disease treated with hemodialysis[J]. Pol Arch Med Wewn, 2012, 122(5):226-234.
[7]王萤萤,赵晓宁,李毓萍,等.超声评价维持性血液透析对尿毒症患者左心结构与功能的影响[J].临床超声医学杂志, 2017, 19(1):34-36.
[8]余坷坷,程瑞洪,王朝晖,等.超声心动图对尿毒症患者透析前后左心室结构及功能的评价[J].疑难病杂志, 2016, 15(4):344-346.
[9]马忠超,李雪,杨瑞衡,等.超声心动图评价透析方式对终末期肾脏病心脏结构及功能的影响[J].中国血液净化, 2016, 15(11):591-594.
[10] SAMAI RS, GAUR AK, HOTCHANDANI R, et al. Patterns of left ventricular hypertrophy in chronic kidney disease:an echocardigraphic evaluation[J]. Indian Heart J, 2012, 63(3):259-268.
[11] KIM DS, KIM SM, KIM JC, et al. Clinical analysis of hemodialysis vascular access:comparision of autogenous arterioveonus fistula and arteriovenous prosthetic graft[J]. Korean J Thorac Cardiovasc Surg,2011, 44(1):25-31.
[12]李奕琼,朱兴华,钟敏.尿毒症患者透析前后超声心动图变化的临床意义[J].现代诊断与治疗, 2015, 26(13):2887-2888.
[13]江涛,王昌富,李军.肾功能不全对应用NT-ProBNP诊断心力衰竭的影响[J].国际检验医学杂志, 2014, 35(10):1343-1344.
[14]王立华,姜埃利,魏芳,等.老年肾替代治疗患者左心室功能异常及相关因素分析[J/CD].中华临床医师杂志:电子版, 2011, 5(8):227-2281.
[15]张群英,龚兰,张强,等.二尖瓣环位移与实时三维超声心动图对尿毒症患者透析前后左心室功能的对比研究[J].中国超声医学杂志,2015, 31(8):760-762.
[16] LIM CT, YAP XH, CHUNG KJ, et al. Predictor of cardiovascular risks in end stage renal failure patients on maintenance dialysis[J].Pak J Med Sci, 2015, 31(6):1300-1305.
[2]胡科丹,邹懿,宋萍,等.三维整体面积应变评价血液透析患者左心功能的研究[J].临床超声医学杂志, 2016, 18(7):448-451.
[3]李爱莉,柯元南,曾玉杰,等.尿毒症维持性血液透析患者左心室构型和功能的超声心动图研究[J].中华心血管病杂志, 2009, 37(10):913-916.
[4]郭佳妮.超声心动图对尿毒症血透患者在透析前后心脏结构与功能改变的研究[J].罕少疾病杂志, 2017, 24(2):35-37.
[5]邓晓莉,冀建峰,刘蓓,等.超声心动图检测尿毒症患者血液透析前后心功能变化[J].心脏杂志, 2016, 28(1):33-34, 37.
[6] NAPORA M, GRACZYKOWSKA A, et al. Relationship between serum asymmetric dimethylarginine and left ventricular structure and function in patients with endstage renal disease treated with hemodialysis[J]. Pol Arch Med Wewn, 2012, 122(5):226-234.
[7]王萤萤,赵晓宁,李毓萍,等.超声评价维持性血液透析对尿毒症患者左心结构与功能的影响[J].临床超声医学杂志, 2017, 19(1):34-36.
[8]余坷坷,程瑞洪,王朝晖,等.超声心动图对尿毒症患者透析前后左心室结构及功能的评价[J].疑难病杂志, 2016, 15(4):344-346.
[9]马忠超,李雪,杨瑞衡,等.超声心动图评价透析方式对终末期肾脏病心脏结构及功能的影响[J].中国血液净化, 2016, 15(11):591-594.
[10] SAMAI RS, GAUR AK, HOTCHANDANI R, et al. Patterns of left ventricular hypertrophy in chronic kidney disease:an echocardigraphic evaluation[J]. Indian Heart J, 2012, 63(3):259-268.
[11] KIM DS, KIM SM, KIM JC, et al. Clinical analysis of hemodialysis vascular access:comparision of autogenous arterioveonus fistula and arteriovenous prosthetic graft[J]. Korean J Thorac Cardiovasc Surg,2011, 44(1):25-31.
[12]李奕琼,朱兴华,钟敏.尿毒症患者透析前后超声心动图变化的临床意义[J].现代诊断与治疗, 2015, 26(13):2887-2888.
[13]江涛,王昌富,李军.肾功能不全对应用NT-ProBNP诊断心力衰竭的影响[J].国际检验医学杂志, 2014, 35(10):1343-1344.
[14]王立华,姜埃利,魏芳,等.老年肾替代治疗患者左心室功能异常及相关因素分析[J/CD].中华临床医师杂志:电子版, 2011, 5(8):227-2281.
[15]张群英,龚兰,张强,等.二尖瓣环位移与实时三维超声心动图对尿毒症患者透析前后左心室功能的对比研究[J].中国超声医学杂志,2015, 31(8):760-762.
[16] LIM CT, YAP XH, CHUNG KJ, et al. Predictor of cardiovascular risks in end stage renal failure patients on maintenance dialysis[J].Pak J Med Sci, 2015, 31(6):1300-1305.