Sadler D B, Brown J, Nurse H, Roberts J
Division of Cardiology, Harlem Hospital Center, College of Physicians & Surgeons, Columbia University, New York, New York 10037.
Am J Med Sci. 1992 Aug;304(2):83-90. doi: 10.1097/00000441-199208000-00003.
Hemodialysis is associated with acute reduction in intravascular volume. To assess the impact of volume reduction on left and right ventricular diastolic filling indexes obtained by Doppler echocardiography, 24 patients on chronic hemodialysis were consecutively studied before, during, and immediately after one hemodialysis session. Twenty four normal sex and age-matched volunteers served as a control group. Study patients had abnormal diastolic indexes when compared to controls. At 2 hours of dialysis (mid dialysis) there was a significant decrease in peak early mitral flow velocity (E), no change in peak atrial filling velocity (A), and a reduction in the E/A ratio. The deceleration time of the mitral E wave also was prolonged compared to baseline. Similar findings were observed with respect to right ventricular filling indices. These changes occurred during the first 2 hours of dialysis and remained unaltered at end dialysis. When patients were subdivided according to weight loss, only the group that lost 1 or more kilograms had significant changes in the Doppler parameters of the left and right ventricle, as well as reduction of the left ventricular dimensions. These findings suggest that preload reduction is the main mechanism that accounts for acute changes in Doppler diastolic indices observed during hemodialysis.
血液透析与血管内容量的急性减少有关。为了评估容量减少对通过多普勒超声心动图获得的左、右心室舒张期充盈指标的影响，对24例慢性血液透析患者在一次血液透析治疗前、治疗期间和治疗后立即进行了连续研究。24名年龄和性别匹配的正常志愿者作为对照组。与对照组相比，研究患者的舒张指标异常。在透析2小时（透析中期）时，二尖瓣早期血流峰值速度（E）显著降低，心房充盈峰值速度（A）无变化，E/A比值降低。与基线相比，二尖瓣E波减速时间也延长。右心室充盈指标也有类似发现。这些变化发生在透析的前2小时，在透析结束时保持不变。当根据体重减轻情况对患者进行细分时，只有体重减轻1千克或更多的组左、右心室多普勒参数有显著变化，同时左心室尺寸减小。这些发现表明，前负荷降低是血液透析期间观察到的多普勒舒张指标急性变化的主要机制。
