Staffeld C G, Pastan S O
Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Cardiol Clin. 1995 May;13(2):209-23.
Cardiovascular diseases remain the leading cause of death in ESRF patients. Coronary risk factors such as hypertension and lipid abnormalities are prevalent in the dialysis population and may be difficult to control. Special factors contributing to the imbalance between myocardial oxygen supply and demand include anemia, arteriovenous fistula, and the hemodialysis procedure itself. LVH and left ventricular dilation frequently result in symptomatic CHF. Atrial and ventricular arrhythmias are common; pericarditis may also occur. Control of the extracellular fluid volume through ultrafiltration with dialysis and the dietary avoidance of salt and water is critical to controlling hypertension in the dialysis population. The potential for drug side effects and the altered pharmacokinetics of medications in renal failure patients should be considered when prescribing cardiovascular drugs.
心血管疾病仍然是终末期肾病患者的主要死因。高血压和血脂异常等冠心病危险因素在透析人群中普遍存在，且可能难以控制。导致心肌供需氧失衡的特殊因素包括贫血、动静脉内瘘和血液透析操作本身。左心室肥厚和左心室扩张常导致有症状的心力衰竭。房性和室性心律失常很常见；心包炎也可能发生。通过透析超滤控制细胞外液量以及在饮食中避免盐和水对于控制透析人群的高血压至关重要。在开具心血管药物处方时，应考虑肾衰竭患者药物副作用的可能性和药物代谢动力学的改变。
