超声评价维持性血液透析对尿毒症患者左心结构与功能的影响

摘要

目的 应用超声评价尿毒症患者维持性血液透析(MHD)后左心结构与功能的变化.方法 选取尿毒症患者(研究组)和健康成人(对照组)各40例,应用超声心动图测量其左房内径(LAD)、左室舒张末期内径(LVIDd)、左室后壁厚度(LVPWd)、室间隔舒张期厚度(IVSD)、二尖瓣舒张早期峰值流速(VE)、二尖瓣舒张晚期峰值流速(VA)、左室射血分数(LVEF)、二尖瓣舒张早期与舒张晚期峰值流速之比(E/A)及二尖瓣舒张早期血流峰值与二尖瓣环运动速度之比(E/e’);计算左室质量(LVM)和左室重量指数(LVMI).MHD治疗1年后,超声心动图再次测量以上指标,与治疗前及对照组进行对比分析.结果 研究组治疗前LAD、LVIDd、LVWPD、IVSD、VE、VA、E/e’、LVM及LVMI均较对照组增大,差异均有统计学意义(均P＜0.05),E/A和LVEF差异无统计学意义.MHD治疗1年后,LAD、LVIDd、LVWPD、IVSD、VE、VA、E/A、E/e’、LVM及LVMI均较治疗前减小,LVEF较治疗前增加,差异均无统计学意义.研究组治疗1年后,LAD、LVIDd、LVWPD、IVSD、VE、VA、E/e’、LVM及LVMI均较对照组增大,差异均有统计学意义(均P＜0.05).结论 超声心动图可对尿毒症患者MHD治疗后左心结构与功能的改善进行有效评价,具有重要临床应用价值.%Objective To evaluate the change of left cardiac structure and function by echocardiography in uremia patients who underwent maintenance hemodialysis (MHD).Methods Forty uremia patients (uremia group)and 40 normal subjects(control group) were included in this study.Left atrial diameter(LAD),left ventricular internal diameter at end-diastole (LVIDd),left ventricular posterior wall diameter(LVPWd),inter-ventricular septum diastolic thickness (IVSD),early diastolic peak velocity(VE),the late diastolic peak flow velocity (VA),ratio of mitral flow E velocity and A velocity (E/A),ratio of mitral flow E velocity and mitral annulus e velocity(E/e'),left ventricular ejection fraction(LVEF) were measured by echocardiography,the left ventricular mass(LVM) and left ventricular mass index(LVMI) were calculated.All above parameters were measured and compared before and after MHD for one year,and compared with the control group.Results LAD,LVIDd,LVWPD,IVSD,VE,VA,E/e',LVM and LVMI were increased obviously in uremia group (all P＜0.05),but there was no significant difference in E/A and LVEF between two groups.LAD,LVIDd,LVWPD,IVSD,VE,VA,E/A,E/e',LVM and LVMI were decreased,LVEF was increased in uremia group.After MHD,however there was no significant difference in all parameters before and after MHD.After MHD,LAD,LVIDd,LVWPD,IVSD,VE,VA,E/e',LVM and LVMI had significantly higher in the uremia group than those in control group (all P＜0.05).Conclusion Echocardiography can well evaluate the change of left cardiac structure and function in uremia patients getting MHD,and has potential clinical application value.