摘要
目的:探讨不同透析用血管通路对老年维持性血液透析患者左心室肥厚及功能的影响。方法:选择航天中心医院肾内科自2005年7月至2012年7月新建立的带涤纶环的长期留置双腔导管(导管组)老年透析患者43例,新建立动静脉内瘘(内瘘组或AVF组)老年透析患者30例,血管通路均使用12个月以上,分别于血管通路建立前以及使用12个月后应用超声心动图测量心脏结构和功能的相关指标,应用彩色多普勒超声测量内瘘口直径(AVFD),根据公式计算出左心室心肌质量指数(LVMI)。同时观察2组透析患者平均血流量、透析前、后实验室指标、尿素清除率(Kt/V)、尿素下降率(URR),观察期间2组感染、血栓发生情况。结果:内瘘组透析后12月LVDd、IVST、LVPWT、及LVMI均较透析前明显升高,差异有统计学意义(P<0.05或0.01),左室收缩功能、左室舒张功能较术前有减低趋势,但差异无统计学意义(均P>0.05);而导管组上述指标较术前无明显变化(均P>0.05)。导管组平均血流量低于内瘘组,C反应蛋白、感染率、血栓发生率均显著高于内瘘组(均P<0.05),而Kt/V、URR及其他实验室检测指标两组间差异无统计学意义(均P>0.05)。结论:长期AVF可明显影响老年血透患者心血管系统的血液动力学,表现为左室心腔扩大、室壁增厚,而心脏收缩和舒张功能未见明显下降,说明老年终末期肾病患者心功能对前臂动-静脉内瘘术有一定的承受和代偿能力。而导管组患者虽然有更高的感染率和血栓发生率,但其对心脏的影响明显小于AVF。
Objective： To evaluate the long-term effects of different blood access on myocardial structure and function in elderly maintenance hemodialysis patients. Methods： Elderly patients between July 2005 and July 2012 were enrolled in this study, including 43 patients with cuffed tunneled catheter （CTC） in an central venous and 30 patients with arteriovenous fistula （AVF） as the longterm hemodialysis access in a follow-up period of 12 months. Eehocardiography was performed before operation and after 12 months of hemodialysis to evaluate the effects of different blood access on the cardiac structure and function, then the left ventricular mass index （LVMI） was calculated by the equation. The diameter of arteriovenous fistula （AVFD） were detected by Doppler ultrasound after 12 months of hemodialysis. To observe their average blood flow during dialysis,laboratory examinations were detected before and after hemodialysis. Dxalysxs adequacy （Kt/V and URR） and complications were compared between the two groups during observation. Results. The echocardiac indices such as LVDd, IVST, LVPWT, and LVMI were apparently increased after 12 months of hemodialysis in patients using AVF, left ventricular systolic and diastolic function had a tendency to reduce as compared with preoperative, but there was no statistically significant difference （P〉0.05）. While the above indicators had no significant changes in patients using CTC （P〉0.05）. The average blood flow is significantly less in CTC group, while the CRP, the prevalence of catheter infection and thrombus were significantly higher in CTC group （P〈0.05）. No difference in Kt/V, urea reduction ratio and other laboratory variables were found between the two groups （P〉0.05）. Conclusion： Long-term AVF remarkably affects the cardiovascular dynamics of aged hemodialysis patients, characterized by the enlargement of left ventricle and the thickening of ventricular wall, while the left ventrictlar systolic function and left ventricular diastolic function did not see obvious drop. And it suggests that the heart function in elderly patients with ESRD can endure and compensate to some extent to forearm arteriovenous fistula surgery. Although catheter group patients have a higher incidence of infection and thrombosis, but its effects on the heart are much less than the AVF.
出处
《武汉大学学报（医学版）》
CAS
北大核心
2014年第2期268-272,276,共6页
Medical Journal of Wuhan University
关键词
老年
血液透析
血管通路
心脏结构和功能
Elderly Patients
Hemodialysis
Long-Term Blood Access
Cardiac Structureand Function
