应用组织多普勒成像技术评价单次透析对尿毒症患者左室功能的急性作用

摘要

目的：探讨应用组织多普勒成像技术(TDI)评价单次透析对尿毒症患者左室收缩及舒张功能的急性作用。方法选取2014年4~9月在三峡大学人民医院透析中心治疗且符合纳入标准的尿毒症患者31例,所有患者无临床心功能障碍表现,于透析前后30 min内各行1次超声心动图检查,使用TDI测量二尖瓣环运动速度,分别用收缩期波峰(S)、舒张早期波峰(Em)及舒张晚期波峰(Am)表示。比较透析前后常规超声及TDI指标结果的差异。结果①常规超声结果：单次透析后,左室收缩功能(LVEF)无显著性改变(P跃0.05),但左室舒张功能(E/A)却显著降低(P<0.01)。②TDI测量结果：单次透析后,患者S值显著降低(P<0.01),Em及Em/Am值亦显著减低(P<0.01)。③左室侧壁Em及Em/Am与透析移除液量呈显著负相关(rEm=-0.60,P<0.05；rEm/Am=-0.69,P<0.01)。结论单次透析过程与尿毒症患者左室收缩及舒张功能急性受损密切联系,可以使用TDI对此进行评价。这种可逆性的改变被认为是心脏的代偿功能,并且这种改变与透析液量相关。对尿毒症透析患者来说,以较少的透析液量透析对左室功能具有保护效应。%Objective To evaluate the acute effects of single hemodialysis on left ventricular function of patients with uremia evaluated by tissue Doppler imaging (TDI). Methods 31 cases of patients with uremia treated in Dialysis Center of Renmin Hospital of China Three Gorges University from April to September 2014 and met with the inclusion criteria were chosen. All the patients had no manifestations of cardiac dysfunction, ultrasonic cardiogram was examined for one time within 30 min before and after hemodialysis, mitral annulus velocity was detected by TDI, which was expressed by ventricular systolic peak (S), early diastolic peak (Em) and advanced diastolic peak (Am) respectively. The differences of indicators of conventional ultrasound and TDI before and after hemodialysis were compared. Results ①Conventional ultrasound results:after single hemodialysis, left ventricular systolic function (LVEF) were not significantly changed (P>0.05), but left ventricular diastolic function (E/A) were significantly reduced (P< 0.01). ②TDI measuring results: after single hemodialysis, the value of peak S was significantly reduced (P<0.01), the values of peak Em and Em/Am were significantly reduced (P<0.01). ③Peak Em and Em/Am ratios of the lateral wall were negatively related to ultrafiltra-tion volume (rEm=-0.60, P<0.05; rEm/Am=-0.69, P<0.01). Conclusion Single hemodialysis is closely associated with a-cute deterioration of left ventricular systolic and diastolic function of patients with uremia, which can be assessed by TDI, these reversible changes can be considered as a cardiac stunning that seems to be related to the ultrafiltration volume. For hemodialysis patients with uremia, low ultrafiltration volume has cardiac protective effects for left ventricu-lar function.