不同透析方式对尿毒症患者左心室功能影响的研究

摘要

目的 观察腹膜透析与血液透析对尿毒症患者左心室收缩功能及舒张功能的影响.方法 选择尿毒症患者72例,分为腹膜透析组38例,血液透析组34例.透析前及透析1a后应用超声心动图检查左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、室间隔厚度(IVST)、左室后壁厚度(LVPWT)、左室射血分数(EF)及舒张早期和晚期最大血流速度比(E/A),舒张早期和晚期血流速度积分比(EI/AI).结果 透析前腹膜透析组与血液透析组之间LVEDD、LVESD、IVST、LVPWT、EF、E/A、EI/AI比较均无显著性差异(P均>0.05);2组透析前LVESD、IVST、LVPWT、E/A、EI/AI等指标与对照组比较均有显著性差异,其中LVESD、LVPWT、E/A均有极显著性差异,P均<0.01.透析1a后2组比较LVEDD、LVESD、IVST、LVPWT、EF、E/A、EI/AI均有显著性差异;血液透析组透析前与透析后比较,LVEDD、LVESD、IVST、LVPWT、EF、E/A、EI/AI均有显著性差异;腹膜透析组透析前与透析后比较,LVEDD、LVESD、IVST、LVPWT、EF均有显著性差异,E/A、EI/AI均无显著性差异.结论 尿毒症患者均存在左心室功能障碍,血液透析对左心功能的影响更明显.%Objective It is to observe the influence of peritoneal dialysis and hemodialysis on the systolic function and diastolic function of left ventricle in uremia patients. Methods 72 patients with uremia were selected and divided into two groups. 38 cases were in peritoneal dialysis group and 34 cases were in hemodialysis group. Left ventricle end-diastole internal diameter ( LVEDD ) and Left ventricle end-systole internal diameter ( LVESD ) . interventricular septal thickness ( IVST ) , left ventricular posterior wall thickness ( LVPWT ), lefl ventricular ejection fraction ( EF％ ) , peak veloity of early stage diastole/peak velocity of advanced stage diastole ( E/A ) and speed of blood flow integral of early stage diastole / speed of blood flow integral of advanced stage diastole ( EI/AI ) hefore dialysis and after dialysis for one year were detected with echocardiogram.Results There were all no significant differences on LVEDD, LVESD, IVST, LVPWT, EF, E/A and EI/AI between peritoneal dialysis group and hemodialysis group hefore dialysis ( all P ＞ 0. 05 ). There were all significant differences on LVESD,IVST , LVPWT, E/A and EI/AI between the two groups and control group before dialysis and among those there were very significant differences on LVESD , LVPWT and E/A ( all P ＜0. 01 ). There were all significant differences on LVEDD, LVESD ,IVST, LVPWT, EF, E/A and EI/AI between the two groups after dialysis for one year. There were all significant differences on LVEDD, LVESD, IVST, LVPWT, EF, E/A and EI/AI in hemodialysis group between before and after dialysis. There were all significant differences on LVEDD , LVESD , IVST, LVPWT and EF in peritoneal dialysis group between before and af ter dialysis, but there was no significant differences on E/A and EI/AI. Conclusion Left ventricle dysfunction exists in all uremia patients. The influence of hemodialysis on left heart function is more obvious.