Szabó Zoltán, Kakuk György, Fülöp Tibor, Mátyus János, Balla József, Kárpáti István, Juhász Attila, Kun Csaba, Karányi Zsolt, Lorincz István
First Department of Medicine, Medical and Health Science Center, University of Debrecen, Hungary.
Nephrol Dial Transplant. 2002 Sep;17(9):1634-8. doi: 10.1093/ndt/17.9.1634.
Analysing a 12-lead surface electrocardiogram (ECG), the inter-lead variability of the P wave interval, i.e. P wave dispersion, is defined as the difference between the maximum and the minimum P wave duration. Our aim was to assess the effect of haemodialysis on P wave duration and dispersion in non-diabetic patients with end-stage renal failure on chronic haemodialysis.
Twenty-eight patients (14 men and 14 women, mean age 58+/-16 years, average duration of dialysis 4.5+/-2.8 years) were examined. Prior to haemodialysis, echocardiography (M-mode and two-dimensional) was performed. Haemodialysis sessions were carried out with polysulfone dialysers and bicarbonate dialysate fluids. Twelve-lead ECGs were recorded at the beginning, 15 and 30 min after starting dialysis, at the end, and 2 h after completion of each session. Ionic parameters were checked during the study. P wave durations were measured with calipers in three consecutive complexes of each lead by one observer.
P maximum was 58+/-16 ms at the beginning, and showed an increase by the end of dialysis to 98+/-8.9 ms (P<0.0001). Pre-dialysis P dispersion was 23+/-10 ms and increased to 41+/-16 ms by the end of the sessions (P<0.0001). In patients with a left atrial diameter larger than 45 mm, P dispersion increased from 23+/-11 to 53+/-10 ms (P<0.0003) by the end of the sessions.
According to our results, ionic imbalance and dialysis itself may cause changes in P duration and dispersion simultaneously.
在分析12导联体表心电图（ECG）时，P波间期的导联间变异性，即P波离散度，定义为最大P波时限与最小P波时限之差。我们的目的是评估血液透析对慢性血液透析的非糖尿病终末期肾衰竭患者P波时限和离散度的影响。
对28例患者（14例男性和14例女性，平均年龄58±16岁，平均透析时间4.5±2.8年）进行检查。在血液透析前，进行超声心动图检查（M型和二维）。使用聚砜透析器和碳酸氢盐透析液进行血液透析治疗。在每次透析开始时、开始后15分钟和30分钟、结束时以及结束后2小时记录12导联心电图。在研究期间检查离子参数。由一名观察者用游标卡尺在每个导联的三个连续复合波中测量P波时限。
开始时P波最大值为58±16毫秒，透析结束时增加到98±8.9毫秒（P<0.0001）。透析前P波离散度为23±10毫秒，透析结束时增加到41±16毫秒（P<0.0001）。左心房直径大于45毫米的患者，透析结束时P波离散度从23±11增加到53±10毫秒（P<0.0003）。
根据我们的结果，离子失衡和透析本身可能同时导致P波时限和离散度的变化。
