论文部分内容阅读
目的:探讨腹膜透析(PD)患者心胸比例变化情况及相关影响因素。方法:选取2010年6月至2011年12月于南京军区南京总医院全军肾脏病研究所行PD置管术的123例终末期肾病(ESRD)患者,观察PD治疗后心脏形态相关指标的变化。患者每3月随访一次,全面评估透析状况,包括血清白蛋白、血红蛋白(Hb)、收缩压、舒张压、体重、体质量指数(BMI)、尿量、超滤量、液体清除量、血钠、每周尿素氮总清除率(Kt/Vtotal)、每周肌酐总清除率(Ccr)、残余肾肾小球滤过率(rGFR)水平,并通过心脏超声和胸部平片检查,每6月对PD患者的心脏形态学指标及功能进行评估,观察其动态变化。结果:(1)随PD时间延长患者心胸比例逐渐增加,透析前、透析后6月、12月时分别为0.465±0.041、0.474±0.045、0.492±0.060(P<0.01),射血分数呈下降趋势(P>0.05)。(2)20例(16.3%)患者出现胸闷、夜间不能平卧等心功能不全表现,分析这些患者临床特点发现,糖尿病肾病7例(35%),难治性高血压16例(80%),持续不卧床腹膜透析8例(40%)且rGFR下降快,贫血重。(3)相关回归分析发现,PD患者心胸比例与BMI(r=0.375,β=0.442)、收缩压(r=0.281,β=0.217)、血红蛋白(r=-0.283,β=-0.199)、液体清除量(r=-0.231,β=-0.851)独立相关。(4)不同rGFR状态下心胸比例不同,rGFR水平为<3ml/(min·1.73m2)、3～6ml/(min·1.73m2)、>6ml/(min·1.73m2),心胸比分别为0.493±0.062、0.468±0.043、0.456±0.042(P<0.05)。结论:随着透析时间的延长,PD患者心脏结构及功能发生改变,除与透析本身导致机体容量负荷持续增高外,与残余肾功能、BMI、Hb、液体清除量及血压状态亦密切相关。
Objective: To investigate the changes of cardiothoracic proportion in patients with peritoneal dialysis (PD) and related factors. Methods: From December 2010 to December 2011, 123 patients with end-stage renal disease (ESRD) undergoing PD catheterization in the PLA General Hospital of Nanjing Military Region in Nanjing Military Region were enrolled. The changes of cardiac morphological indexes were observed after PD treatment . Patients were followed up every 3 months to fully assess the status of dialysis including serum albumin, hemoglobin (Hb), systolic blood pressure, diastolic blood pressure, body weight, body mass index (BMI), urine output, ultrafiltration volume, fluid clearance, , Total weekly urea nitrogen (Kt / Vtotal), total weekly creatinine clearance (Ccr) and residual renal glomerular filtration rate (rGFR) were measured by echocardiography and chest radiography. The PD patients’ cardiac morphological indexes and functions were evaluated and their dynamic changes were observed. Results: (1) The proportion of cardiothorax gradually increased with the prolongation of PD. Before dialysis, the ejection fraction decreased to 0.465 ± 0.041, 0.474 ± 0.045 and 0.492 ± 0.060 respectively at 6 and 12 months after dialysis (P <0.01) Trend (P> 0.05). (2) Twenty patients (16.3%) had chest distress and could not be supine at night. The clinical features of these patients were analyzed. Among them, 7 patients (35%) had diabetic nephropathy and 16 (80%) patients had refractory hypertension , Continuous ambulatory peritoneal dialysis in 8 cases (40%) and rGFR decreased rapidly, anemia. (3) Correlation analysis showed that the ratio of cardiothoracic to PD in patients with PD was significantly higher than that of BMI (r = 0.375, β = 0.442), systolic blood pressure (r = 0.281, β = 0.217), hemoglobin Clearance (r = -0.231, β = -0.851) independent correlation. (4) The rate of rGFR in different rGFR state was different, the level of rGFR was <3ml / (min · 1.73m2), 3 ~ 6ml / (min · 1.73m2),> 6ml / (min · 1.73m2) ± 0.062,0.468 ± 0.043,0.456 ± 0.042 (P <0.05). CONCLUSION: With the prolongation of dialysis, the structure and function of heart in PD patients are changed. Except dialysis itself, the capacity load of the body continues to increase. It is also closely related to residual renal function, BMI, Hb, fluid clearance and blood pressure status.