超声心动图评价肾移植术前不同血液透析时间对尿毒症患者心脏结构和功能的影响

摘要

目的探讨肾移植术前不同血液透析时间对原发性肾小球肾炎尿毒症患者心脏结构与功能的影响。方法根据肾移植术前是否血液透析和不同血液透析时间对206例原发性肾小球肾炎尿毒症患者进行分组：透析龄≤1年（90例）、透析龄≤3年（77例）、透析龄＞3年（39例）共3组，应用超声心动图测量3组患者肾移植前、肾移植后1个月和3个月的左心室结构和功能的参数，并进行比较。结果肾移植术后患者左心收缩及舒张功能均有降低趋势；心脏各房、室腔均有不同程度缩小，室间隔和室壁搏幅增加，厚度变薄，左心室短轴缩短率、左心室射血分数等心功能测值较肾移植术前明显改善，扩大的左心房、左心室较肾移植术前缩小。尤其术前透析龄≤1年组患者，心肌和心脏明显缩小。肾移植术后二尖瓣口舒张早期血流峰值流速升高，舒张晚期峰值流速降低，E／A比值升高，E峰减速时间及等容舒张时间明显缩短。透析龄≤1年、透析龄≤3年、透析龄＞3年的患者术前、术后1个月、术后3个月左心房收缩末期内径、左心室舒张末期内径、左心室收缩末期内径、室间隔厚度、左心室后壁厚度、左心室短轴缩短率、左心室射血分数、二尖瓣E峰最大流速、二尖瓣A峰最大流速、E／A比值、E峰减速时间、左心室等容舒张时间比较，差异均有统计学意义（P＜0．01）；透析龄≤1年的患者分别与透析龄≤3年、透析龄＞3年组患者比较，各参数间差异均有统计学意义（P ＜0．01）。结论随血液透析时间的延长，原发性肾小球肾炎尿毒症患者心脏结构和功能均逐渐发生变化，应尽可能缩短肾移植术前血液透析时间，避免透析时间多于1年，以提高长期存活率，减少术后并发症的发生率。%Objective To compare the structure and function of left ventricular before and after renal transplantation .To discover the effect of kidney transplantation based on different dialysis duration . Methods Two handred six pre-renal transplants were assigned into 3 groups based on the dialysis duration:group A, non-dialyzed group,≤1 year group (90 cases); group B, ≤3 years group (77 cases);group C,>3 years group (39 cases).The structure and function of left ventricular was evaluated 1 and 3 months after kidney transplantation using Echocardiography .Results The echocardiographic results of all 3 groups showed decrease of the heart chambers , the thickness of interventricular septum and left ventricular posterior wall.The left ventricular short axis shorten rate and the left ventricular ejection fraction improved .For patients with no dialysis or less than 1 year, the heart size decreased significantly .The early diastolic peak velocity of mitral valve increased, the late diastolic peak velocity decreased , the E/A value rose, the E peak deceleration time and the isovolumic relaxation time shorten remarkably .The left ventricular structure and function improvement of pre-transplant, 1 month and 3 months after transplant in group A was more significant than that in group B and C(P<0.01).Conclusions The structure and function of left ventricular change gradually with the extended dialysis duration before renal transplantation .Shorten the dialysis duration to less than 1 year would be beneficial to prolonged survival rate and reduced incidence of renal transplant complication .