慢性维持性血液透析患者透析液浴和 QTc 间期：单次透析影响的初步研究。

Dialysate bath and QTc interval in patients on chronic maintenance hemodialysis: pilot study of single dialysis effects.

机构信息

Complex Operative Unit of Nephrology, ASL Avellino, A. Landolfi Hospital, Solofra, Avellino, Italy.

出版信息

J Nephrol. 2012 Sep-Oct;25(5):653-60. doi: 10.5301/jn.5000036.

DOI:10.5301/jn.5000036

PMID:21983985

Abstract

INTRODUCTION

Serum concentrations of potassium (K) and calcium (Ca) influence ionic currents and play an important role in the duration of ventricular action potential. Further, the influence of alkalosis in reducing ionized calcium has been well known for a long time. The aim of this study was to assess the effects of different dialysate electrolytes and bicarbonate concentrations on changes of QTc interval in patients on chronic hemodialysis.

METHODS

The study hemodialysis sessions were performed in 22 patients, with different electrolyte and bicarbonate concentrations in dialysate. Tested dialysate concentrations were K of 2 and 3 mmol/L; Ca 1.25, 1.5 and 1.75 mmol/L; and bicarbonate 30 and 34 mmol/L. An electrocardiogram (ECG) was recorded 1 hour before, at the end and every hour for 4 hours after each study dialysis session. QTc interval was measured from the beginning of the QRS complex to the end of a T wave on a 12-lead ECG. Blood was collected and K, total Ca, ionic Ca and pH evaluated.

RESULTS

At the end of the study hemodialysis session with dialysate containing low K (2 mmol/L), low Ca (1.25 mmol/L) and high bicarbonate concentration (34 mmol), mean QTc interval was significantly prolonged compared with that recorded with dialysate containing high K (3 mmol/L), high Ca (1.75 mmol/L) and bicarbonate (30 mmol) (40 ± 10 milliseconds vs. 2 ± 2 milliseconds; p<0.01). Dialysate with low concentration of low Ca, K and high concentration of bicarbonate was an independent predictor of QTc; the combination of low Ca and K and high bicarbonate strongly increased the risk of prolonged QTc interval.

CONCLUSION

The present pilot study shows that changes in QTc interval during hemodialysis depend on both electrolyte and bicarbonate concentrations in dialysate.

摘要

简介

血清钾（K）和钙（Ca）浓度影响离子电流，在心室动作电位持续时间中起重要作用。此外，碱中毒降低离子化钙的影响已经被人们熟知了很长时间。本研究的目的是评估不同透析液电解质和碳酸氢盐浓度对慢性血液透析患者 QTc 间期变化的影响。

方法

在 22 名患者中进行了血液透析研究，使用不同的透析液电解质和碳酸氢盐浓度。测试的透析液浓度为 K 2 和 3 mmol/L；Ca 1.25、1.5 和 1.75 mmol/L；和碳酸氢盐 30 和 34 mmol/L。在每次研究性透析治疗前 1 小时、结束时以及结束后 4 小时每小时记录心电图（ECG）。从 QRS 波群开始到 12 导联心电图上 T 波结束测量 QTc 间期。采集血液并评估 K、总 Ca、离子 Ca 和 pH 值。

结果

在透析液中含有低钾（2 mmol/L）、低钙（1.25 mmol/L）和高碳酸氢盐浓度（34 mmol）的研究性血液透析结束时，与透析液中含有高 K（3 mmol/L）、高 Ca（1.75 mmol/L）和碳酸氢盐（30 mmol）时相比，平均 QTc 间期明显延长（40±10 毫秒 vs. 2±2 毫秒；p<0.01）。低 Ca、K 和高碳酸氢盐浓度的透析液是 QTc 延长的独立预测因子；低 Ca 和 K 与高碳酸氢盐的结合强烈增加了 QTc 间期延长的风险。