Department of Renal Medicine, Royal Derby Hospital, Derby, UK.
Perit Dial Int. 2011 Jan-Feb;31(1):27-33. doi: 10.3747/pdi.2010.00007. Epub 2010 Jun 3.
Hemodynamic changes during hemodialysis can precipitate subclinical myocardial ischemia, which over time contributes to the development of cardiac failure and is associated with a poor prognosis. Peritoneal dialysis (PD) is also associated with acute changes in systemic hemodynamics and a similarly high incidence of cardiovascular disease; we therefore sought to examine whether the hemodynamic effects of a PD exchange would be sufficient to induce subclinical myocardial ischemia.
10 patients on PD entered a prospective observational study to determine whether left ventricular (LV) regional wall motion abnormalities (RWMAs) developed following a dialysate exchange. Serial echocardiography with quantitative analysis was used to assess ejection fraction and regional systolic LV function (shortening fraction). Blood pressure (BP) and hemodynamic variables were measured using continuous pulse wave analysis.
We observed a very low frequency of RWMA development (5/100 regions). Only 1 patient had more than 1 RWMA and 6 patients were entirely unaffected. Overall mean shortening fraction increased when comparing pre and post values for both 2-chamber (from 3.06% ± 1.5% to 4.26% ± 1.3%, p = 0.001) and 4-chamber (from 3.00% ± 0.7% to 3.67% ± 0.9%, p = 0.021) analyses. Mean arterial pressure fell by a small degree during drainage of dialysate, with a larger rise in BP observed during instillation. These changes were driven by changes in peripheral resistance that fell during drainage and rose during instillation.
In contrast to hemodialysis, the acute effects of PD do not result in subclinical myocardial ischemia.
血液透析过程中的血液动力学变化可引发亚临床心肌缺血，随着时间的推移，这会导致心力衰竭的发展，并与预后不良相关。腹膜透析（PD）也与全身血液动力学的急性变化和类似高心血管疾病发病率相关；因此，我们试图研究 PD 交换是否会引起足够的血液动力学效应导致亚临床心肌缺血。
10 名 PD 患者参与了一项前瞻性观察性研究，以确定在透析液交换后是否会出现左心室（LV）局部壁运动异常（RWMAs）。使用定量分析连续进行超声心动图检查，以评估射血分数和局部收缩 LV 功能（缩短分数）。使用连续脉搏波分析测量血压（BP）和血液动力学变量。
我们观察到 RWMA 发展的频率非常低（5/100 个区域）。只有 1 名患者有超过 1 个 RWMA，6 名患者完全未受影响。比较前后值时，整体平均缩短分数增加，无论是 2 腔（从 3.06%±1.5%增加到 4.26%±1.3%，p=0.001）还是 4 腔（从 3.00%±0.7%增加到 3.67%±0.9%，p=0.021）分析。在排出透析液期间，平均动脉压略有下降，在灌入时观察到血压较大幅度上升。这些变化是由引流期间外周阻力下降和灌入期间外周阻力上升引起的。
与血液透析相反，PD 的急性效应不会导致亚临床心肌缺血。
