血液透析诱导的区域性左心室收缩功能障碍：患病率、患者和透析治疗相关因素及预后意义。
Hemodialysis-induced regional left ventricular systolic dysfunction: prevalence, patient and dialysis treatment-related factors, and prognostic significance.
机构信息
Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen, The Netherlands.
出版信息
Clin J Am Soc Nephrol. 2012 Oct;7(10):1615-23. doi: 10.2215/CJN.00850112. Epub 2012 Jul 19.
BACKGROUND AND OBJECTIVES
The hemodialysis procedure may acutely induce regional left ventricular systolic dysfunction. This study evaluated the prevalence, time course, and associated patient- and dialysis-related factors of this entity and its association with outcome.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Hemodialysis patients (105) on a three times per week dialysis schedule were studied between March of 2009 and March of 2010. Echocardiography was performed before dialysis, at 60 and 180 minutes intradialysis, and at 30 minutes postdialysis. Hemodialysis-induced regional left ventricular systolic dysfunction was defined as an increase in wall motion score in more than or equal to two segments.
RESULTS
Hemodialysis-induced regional left ventricular systolic dysfunction occurred in 29 (27%) patients; 17 patients developed regional left ventricular systolic dysfunction 60 minutes after onset of dialysis. Patients with hemodialysis-induced left ventricular systolic dysfunction were more often male, had higher left ventricular mass index, and had worse predialysis left ventricular systolic function (left ventricular ejection fraction). The course of blood volume, BP, heart rate, electrolytes, and acid-base parameters during dialysis did not differ significantly between the two groups. Patients with hemodialysis-induced regional left ventricular systolic dysfunction had a significantly higher mortality after correction for age, sex, dialysis vintage, diabetes, cardiovascular history, ultrafiltration volume, left ventricular mass index, and predialysis wall motion score index.
CONCLUSIONS
Hemodialysis induces regional wall motion abnormalities in a significant proportion of patients, and these changes are independently associated with increased mortality. Hemodialysis-induced regional left ventricular systolic dysfunction occurs early during hemodialysis and is not related to changes in blood volume, electrolytes, and acid-base parameters.
背景与目的
血液透析过程可能会急性诱发局部左心室收缩功能障碍。本研究评估了这种情况的患病率、时间进程以及与患者和透析相关的因素，并评估了其与预后的相关性。
设计、地点、参与者和测量方法：2009 年 3 月至 2010 年 3 月期间，对每周三次透析方案的血液透析患者（105 例）进行了研究。在透析前、透析 60 分钟和 180 分钟以及透析后 30 分钟进行超声心动图检查。血液透析引起的局部左心室收缩功能障碍定义为超过或等于两个节段的壁运动评分增加。
结果
29 例（27%）患者出现血液透析引起的局部左心室收缩功能障碍；17 例患者在透析开始后 60 分钟出现局部左心室收缩功能障碍。发生血液透析诱导的左心室收缩功能障碍的患者中，男性更多，左心室质量指数更高，透析前左心室收缩功能更差（左心室射血分数）。两组患者在透析过程中的血容量、血压、心率、电解质和酸碱参数的变化无显著差异。校正年龄、性别、透析时间、糖尿病、心血管病史、超滤量、左心室质量指数和透析前壁运动评分指数后，发生血液透析诱导的局部左心室收缩功能障碍的患者死亡率显著更高。
结论
血液透析会导致相当一部分患者出现局部壁运动异常，这些变化与死亡率增加独立相关。血液透析诱导的局部左心室收缩功能障碍在血液透析早期发生，与血容量、电解质和酸碱参数的变化无关。
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