Alpert M A, Van Stone J, Twardowski Z J, Ruder M A, Whiting R B, Kelly D L, Madsen B R
Clin Cardiol. 1986 Feb;9(2):52-60. doi: 10.1002/clc.4960090202.
To assess the comparative cardiac effects of hemodialysis and continuous ambulatory peritoneal dialysis (CAPD), we performed M-mode echocardiography prior to and immediately following hemodialysis on 56 patients and during the dwell phase of CAPD on 39 patients. Hemodialysis produced a significant increase in the mean velocity of circumferential fiber shortening (VCF, an index of left ventricular systolic function) in patients with low VCF prior to dialysis, but resulted in no significant change in VCF in patients with normal predialysis VCF. Hemodialysis produced a significant increase in VCF in patients with a normal predialysis left ventricular end-diastolic volume index (LVEDVI), but resulted in no significant change in VCF in patients with left ventricular dilatation prior to dialysis. Hemodialysis produced a significant decrease in mean LVEDVI and mean stroke index, but resulted in no significant change in mean cardiac index due to a reflex increase in heart rate. Mean LVEDVI, mean stroke index, and VCF values in patients on CAPD were not significantly different from those observed immediately following hemodialysis. Mean cardiac index and mean heart rate were significantly lower in CAPD patients than in posthemodialysis patients. Pericardial effusion was observed in 25% of hemodialysis patients and 5% of CAPD patients (p less than 0.05). We conclude (1) the effects of hemodialysis on left ventricular performance are variable and depend in part on predialysis left ventricular volume and left ventricular systolic function, (2) except for a lower cardiac index, left ventricular hemodynamics for CAPD patients resemble those of posthemodialysis patients, and (3) pericardial effusion occurs with significantly higher frequency in patients on hemodialysis than in those on CAPD.
为评估血液透析和持续性非卧床腹膜透析（CAPD）对心脏的比较影响，我们对56例患者在血液透析前及透析后即刻进行了M型超声心动图检查，并对39例CAPD患者在留腹阶段进行了检查。血液透析使透析前圆周纤维缩短平均速度（VCF，左心室收缩功能指标）较低的患者的VCF显著增加，但透析前VCF正常的患者其VCF无显著变化。血液透析使透析前左心室舒张末期容积指数（LVEDVI）正常的患者的VCF显著增加，但透析前左心室扩张的患者其VCF无显著变化。血液透析使平均LVEDVI和平均每搏指数显著降低，但由于心率反射性增加，平均心脏指数无显著变化。CAPD患者的平均LVEDVI、平均每搏指数和VCF值与血液透析后即刻观察到的值无显著差异。CAPD患者的平均心脏指数和平均心率显著低于血液透析后的患者。25%的血液透析患者和5%的CAPD患者观察到心包积液（p<0.05）。我们得出结论：（1）血液透析对左心室功能的影响是可变的，部分取决于透析前左心室容积和左心室收缩功能；（2）除心脏指数较低外，CAPD患者的左心室血流动力学与血液透析后的患者相似；（3）血液透析患者心包积液的发生率显著高于CAPD患者。
