接受慢性血液透析的尿毒症患者的动态QT间期分析

Dynamic QT interval analysis in uraemic patients receiving chronic haemodialysis.

作者信息

Genovesi Simonetta, Rivera Rodolfo, Fabbrini Paolo, Dossi Chiara, Bonforte Giuseppe, Mircoli Luca, Ferrari Alberto U, Stella Andrea, Stramba-Badiale Marco

机构信息

DIMEP Università degli Studi di Milano Bicocca, Monza, Ospedale di Desio, Desio, Italy.

出版信息

J Hypertens. 2003 Oct;21(10):1921-6. doi: 10.1097/00004872-200310000-00020.

DOI:10.1097/00004872-200310000-00020

PMID:14508199

Abstract

OBJECTIVE

To analyse the duration of the QT interval and its relationship with heart rate changes in patients with uraemia, before and during haemodialysis.

METHODS

QT and RR intervals were measured automatically using a dedicated algorithm with 24-h Holter recordings in 29 patients (15 women) receiving chronic haemodialysis. QT corrected for heart rate (QTc) and the slope of QT/RR linear regression were calculated. Arterial blood pressure (ABP) was measured before and during haemodialysis. Plasma concentrations of K+, Mg2+ and Ca2+ were assessed before and after haemodialysis.

RESULTS

ABP decreased significantly from baseline (102.7 +/- 11.0 mmHg) during the first (100.6 +/- 8.8 mmHg, P < 0.05), second (95.6 +/- 10.6 mmHg, P < 0.05), and third (94.9 +/- 10.3 mmHg, P < 0.05) hours of haemodialysis. QTc was longer during haemodialysis than during a 4-h period of no dialysis (447 +/- 28 ms compared with 429 +/- 22 ms, P < 0.001), and increased progressively during haemodialysis, with the greatest value during the last hour of haemodialysis (454 +/- 32 ms compared with 426 +/- 22 ms, P < 0.001). QT/RR slopes and correlation coefficients were lower during haemodialysis than during the period of no dialysis (0.13 +/- 0.08 compared with 0.20 +/- 0.07, P < 0.001 and 0.48 +/- 0.30 compared with 0.81 +/- 0.20, respectively; P < 0.001), suggesting a reduced ability to adapt the QT interval in response to changes in heart rate. The effects of haemodialysis on QT interval and the QT/RR relationship were greater in women than in men. QTc variations during dialysis were not correlated with changes in ABP, but were inversely related to changes in Ca2+ concentration (r2 = 0.35; P = 0.001).

CONCLUSIONS

In patients with uraemia, the haemodialysis session induces a progressive increase in QT interval and modifies its relationship with heart rate. These effects may predispose some individuals to ventricular arrhythmias at the end of and immediately after the haemodialysis session.

摘要

目的

分析尿毒症患者血液透析前及透析过程中QT间期的时长及其与心率变化的关系。

方法

采用专用算法自动测量29例接受慢性血液透析的患者（15名女性）24小时动态心电图记录中的QT和RR间期。计算校正心率后的QT（QTc）以及QT/RR线性回归斜率。在血液透析前及透析过程中测量动脉血压（ABP）。评估血液透析前后血浆K⁺、Mg²⁺和Ca²⁺浓度。

结果

血液透析第1小时（100.6±8.8 mmHg，P<0.05）、第2小时（95.6±10.6 mmHg，P<0.05）和第3小时（94.9±10.3 mmHg，P<0.05），ABP较基线水平（102.7±11.0 mmHg）显著降低。血液透析期间的QTc长于4小时未透析期间（分别为447±28 ms和429±22 ms，P<0.001），且在血液透析过程中逐渐增加，在血液透析最后1小时达到最大值（分别为454±32 ms和426±22 ms，P<0.001）。血液透析期间的QT/RR斜率和相关系数低于未透析期间（分别为0.13±0.08和0.20±0.07，P<0.001；以及0.48±0.3和0.81±0.20，P<0.001），提示响应心率变化时调整QT间期的能力降低。血液透析对QT间期及QT/RR关系的影响在女性中大于男性。透析期间QTc变化与ABP变化无关，但与Ca²⁺浓度变化呈负相关（r² = 0.35；P = 0.001）。