Gonsorcík J, Szakács M, Palko S, Mydlík M
IV. interná klinika FN L. Pasteura, Kosice.
Vnitr Lek. 1996 Dec;42(12):837-41.
Cardiovascular complications are the main causes of morbidity and mortality of patients on regular dialysis treatment. Myocardial ischaemia in those patients may be promoted apart from accelerated atherosclerosis also by many extracoronary and extracardial factors. In a group of 60 haemodialyzed patients followed up on a long-term basis silent myocardial ischaemia is encountered during 24-hour Holter monitoring in 30-40% of the examined patients. Its occurrence at the end of haemodialysis and during the early posthemodialytic period and its long persistence are typical. The authors examined 20 regularly dialyzed patients with transient depressions of the ST segment in whom they tested retarded nitroglycerin, metoprolol and verapamil. All three drugs had a significant effect on the myocardial ischaemia (intensity and duration of depressions of the ST segment). In addition to correction of the modifying factors of silent myocardial ischaemia the authors prefer verapamil in order to influence the negative sequelae of secondary hyperparathyroidism. If pharmacotherapy of myocardial ischaemia is ineffective, in patients on regular dialysis treatment stress radionuclide scintigraphy or echocardiography and selective coronarography are indicated, which decide on a possible revascularization operation in these risk patients already during the pretransplantation period.
心血管并发症是接受规律透析治疗患者发病和死亡的主要原因。除了加速动脉粥样硬化外，许多冠状动脉外和心外因素也可能促使这些患者发生心肌缺血。在一组60例长期接受血液透析的患者中，24小时动态心电图监测发现30% - 40%的受检患者存在无症状性心肌缺血。其典型表现为在血液透析结束时、血液透析后早期出现，且持续时间较长。作者对20例有ST段短暂压低的规律透析患者进行了研究，对他们使用了缓释硝酸甘油、美托洛尔和维拉帕米进行试验。这三种药物对心肌缺血（ST段压低的程度和持续时间）均有显著影响。除了纠正无症状性心肌缺血的影响因素外，作者更倾向于使用维拉帕米来影响继发性甲状旁腺功能亢进的不良后果。如果心肌缺血的药物治疗无效，对于规律透析治疗的患者，建议进行负荷放射性核素闪烁扫描或超声心动图检查以及选择性冠状动脉造影，这些检查可以在移植前期就确定这些高危患者是否可能进行血管重建手术。
