Kinoshita O, Kimura G, Kamakura S, Haze K, Kuramochi M, Shimomura K, Omae T
Department of Medicine, National Cardiovascular Center, Osaka, Japan.
Nephron. 1993;64(4):580-6. doi: 10.1159/000187404.
To examine the effects of hemodialysis on the electrocardiogram, 87-lead body surface maps were performed in 38 patients with chronic renal failure, before and after hemodialysis. The patients were divided into two groups; 16 patients with coronary artery disease (CAD group), and 22 patients without ischemic heart disease (control group). Three maps were analyzed, QRS isopotential maps, isochrone maps, and QRS isointegral maps. Parameters measured were maximal R wave voltage (Peak R), minimal QRS wave voltage (Peak S), maximal ventricular activation time (VATmax) and QRS duration (QRSd). In the control group, Peak R and Peak S increased but VATmax decreased after hemodialysis. There were negative correlations between the changes of body weight and the changes in Peak R (r = -0.67, p < 0.01) and Peak S (r = -0.87, p < 0.001), although there were no correlations between changes in left ventricular diastolic dimension and the changes in Peak R and Peak S. In the CAD group, Peak S increased but Peak R and VATmax did not change significantly. There were negative correlations between the change of body weight and the change of Peak S (r = -0.73, p < 0.01). The most pronounced changes in mean QRS isointegral maps on hemodialysis were an increased magnitude of positivity in the control group and negativity in the CAD group on the anterior thorax. These findings suggested that the increase in the QRS amplitude after hemodialysis was influenced by the changes of the conductivity of extracardiac thorax and the relative heart position to the chest wall rather than myocardial ischemia or ventricular conduction delay.
为研究血液透析对心电图的影响，对38例慢性肾衰竭患者在血液透析前后进行了87导联体表心电图描记。患者分为两组：16例冠心病患者（CAD组）和22例无缺血性心脏病患者（对照组）。分析了三种心电图：QRS等电位图、等时线图和QRS等积分图。测量的参数有最大R波电压（Peak R）、最小QRS波电压（Peak S）、最大心室激动时间（VATmax）和QRS时限（QRSd）。对照组中，血液透析后Peak R和Peak S升高，但VATmax降低。体重变化与Peak R变化（r = -0.67，p < 0.01）及Peak S变化（r = -0.87，p < 0.001）之间存在负相关，尽管左心室舒张内径变化与Peak R和Peak S变化之间无相关性。在CAD组，Peak S升高，但Peak R和VATmax无显著变化。体重变化与Peak S变化之间存在负相关（r = -0.73，p < 0.01）。血液透析时平均QRS等积分图最明显的变化是，对照组前胸的正性幅度增加，CAD组前胸的负性幅度增加。这些发现提示，血液透析后QRS波振幅的增加受心外胸部电导率变化以及心脏相对于胸壁的相对位置变化的影响，而非心肌缺血或心室传导延迟的影响。
