原代透析心脏功能与透析期间的病态事件有关。

Proto-dialytic cardiac function relates to intra-dialytic morbid events.

机构信息

Department of Internal Medicine, Krankenhaus der Barmherzigen Brüder, Marschallgasse 12, A-8020 Graz, Austria.

出版信息

Nephrol Dial Transplant. 2011 May;26(5):1645-51. doi: 10.1093/ndt/gfq599. Epub 2010 Oct 5.

DOI:10.1093/ndt/gfq599

PMID:20923927

Abstract

BACKGROUND

Intra-dialytic morbid events (IDME) such as intra-dialytic hypotension (IDH) and muscle cramps frequently complicate haemodialysis (HD). Cardiac dysfunction is highly prevalent in HD patients. We investigated the relationship between proto-dialytic (i.e. early intra-dialytic) cardiac function and IDME in HD patients.

METHODS

Heart rate, beat-to-beat blood pressure (BP) and cardiac output were continuously measured during the first 30 min of dialysis treatment using the Task Force™ Monitor. Total peripheral resistance index (TPRI) was calculated from cardiac index (CI) and BP. Univariate, multivariate and logistic regression analyses were employed to relate IDME to haemodynamic predictors; Kaplan-Meier method was employed for time-to-event analysis.

RESULTS

Fourteen HD patients (age 67 ± 15 years; 7 females) were studied. Dialysis treatment was complicated by IDH and muscle cramps in 4 and 8 out of 30 sessions, respectively. CI was higher in patients without IDME (2.6 ± 0.5 L/min/m(2)) as compared to those with muscle cramps (2.0 ± 0.3 L/min/m(2)) or IDH (1.8 ± 0.2 L/min/m(2); all P < 0.05). CI and TPRI at baseline independently predicted IDME in a multivariate regression analysis (odds ratio: 0.043 per unit of CI, 95% confidence interval: 0.003-0.611; odds ratio: 1.124 per unit of TPRI, 95% confidence interval: 1.25-1.01). Patients were stratified by tertiles of CI. IDME occurred in the two lower tertiles, whereas patients in the upper tertile were event free (log-rank test, P < 0.002).

CONCLUSIONS

Low CI and high TPRI in the first 30 min of HD are associated with an increased risk of IDME.

摘要

背景

血液透析（HD）过程中常出现一些并发症，如透析中低血压（IDH）和肌肉痉挛等，这些并发症被称为透析内病况（IDME）。HD 患者中心脏功能障碍的发生率很高。我们研究了 HD 患者在透析前（即透析早期）心脏功能与 IDME 之间的关系。

方法

使用 Task Force Monitor 在透析治疗的前 30 分钟内连续测量心率、逐搏血压（BP）和心输出量。从心输出量（CI）和血压计算总外周阻力指数（TPRI）。采用单变量、多变量和逻辑回归分析将 IDME 与血液动力学预测因子相关联；采用 Kaplan-Meier 方法进行事件时间分析。

结果

研究了 14 名 HD 患者（年龄 67 ± 15 岁；7 名女性）。在 30 次透析治疗中，分别有 4 次和 8 次出现 IDH 和肌肉痉挛。与发生肌肉痉挛（2.0 ± 0.3 L/min/m²）或 IDH（1.8 ± 0.2 L/min/m²）的患者相比，无 IDME 的患者 CI 更高（2.6 ± 0.5 L/min/m²；所有 P < 0.05）。多变量回归分析显示，CI 和 TPRI 基线值可独立预测 IDME（CI 每单位增加的比值比：0.043，95%置信区间：0.003-0.611；TPRI 每单位增加的比值比：1.124，95%置信区间：1.25-1.01）。根据 CI 的三分位数将患者分层。IDME 发生在两个较低的三分位数中，而处于较高三分位数的患者则无事件发生（对数秩检验，P < 0.002）。