CAJ | 학술논문

[目的]探讨延长透析时间，并采用降低血流量与降低透析液流量对尿毒症患者心血管系统的影响。[方法]选取2009年5月至2011年5月本院肾病内科诊治的60例血液透析患者，按照随机配对原则将患者分为试验组和对照组，试验组30例，每次透析时间为8～10 h ，透析液流量300 mL/min ，血流量150～200 mL/min ，透析频率隔日一次；对照组30例，每次透析时间4．5 h ，透析液流量500 mL/min ，血流量250 mL/min ，透析频率隔日一次。比较两组患者心血管事件发生概率，超声心动图监测治疗前后心功能指标的变化。[结果]试验组患者高血压、低血压、心力衰竭、心律失常等心血管事件总发生率为12．36％（267/1260）较对照组26．88％（582/2165）显著降低，且两者相比较差异有显著性（ P ＜0．05）；试验组透析后心脏收缩功能指标：每分搏出量、左心射血分数和左心室质量指数以及舒张功能指标均较治疗前明显好转（ P ＜0．05），对照组各项指标治疗前后无明显变化（ P ＞0．05）；试验组治疗后的效果显著优于对照组，且两者相比较差异有显著性（ P ＜0．05）。[结论]长时透析和采用低透析液流量、低血流量能够显著降低血压，改善心功能，逆转左心室重构，提高患者生存质量，值得临床推广。
[목적]탐토연장투석시간，병채용강저혈류량여강저투석액류량대뇨독증환자심혈관계통적영향。[방법]선취2009년5월지2011년5월본원신병내과진치적60례혈액투석환자，안조수궤배대원칙장환자분위시험조화대조조，시험조30례，매차투석시간위8～10 h ，투석액류량300 mL/min ，혈류량150～200 mL/min ，투석빈솔격일일차；대조조30례，매차투석시간4．5 h ，투석액류량500 mL/min ，혈류량250 mL/min ，투석빈솔격일일차。비교량조환자심혈관사건발생개솔，초성심동도감측치료전후심공능지표적변화。[결과]시험조환자고혈압、저혈압、심력쇠갈、심률실상등심혈관사건총발생솔위12．36％（267/1260）교대조조26．88％（582/2165）현저강저，차량자상비교차이유현저성（ P ＜0．05）；시험조투석후심장수축공능지표：매분박출량、좌심사혈분수화좌심실질량지수이급서장공능지표균교치료전명현호전（ P ＜0．05），대조조각항지표치료전후무명현변화（ P ＞0．05）；시험조치료후적효과현저우우대조조，차량자상비교차이유현저성（ P ＜0．05）。[결론]장시투석화채용저투석액류량、저혈류량능구현저강저혈압，개선심공능，역전좌심실중구，제고환자생존질량，치득림상추엄。
[Objective] To explore the effect of the prolongation of dialysis time ,the decreasing of blood flow and dialysate flow on cardiovascular system of patients with uremia .[Methods] Totally 60 patients with dialysis in urological department of central hospital of Shuizhou city from May 2009 to May 2011 were chosen . According to the random pair rules ,all patients were divided into experimental group and control group .In ex-perimental group( n = 30) ,every dialysis time was 8~ 10h ,and dialysate flow rate was 300mL/min ,and blood flow was 150~200mL/min ,and dialysis frequency was once per other day .In control group( n =30) , every dialysis time was 4 .5h ,and dialysate flow rate was 500mL/min ,and blood flow was 250ml/min ,and di-alysis frequency was once per other day .The probability of cardiovascular events and the changes of cardiac function indexed before and after treatment monitored by echocardiography was compared between two groups .[Results] The total incidence of hypertension ,hypotension ,heart failure ,arrhythmia and other cardiovascular events in experimental group was 12 .36% (267/1260) ,which was lower than that in control group(26 .88% , 582/2165) ,and there was significant difference between them ( P <0 .05) .Cardiac systolic function indexes such as stroke volume ,left cardiac ejection fraction ,left ventricular mass index and diastolic function in exper-imental group after dialysis were better than before treatment ( P<0 .05) .There was no significant difference in all indexes of the control group between before and after treatment ( P>0 .05) .The efficacy of experimental group after treatment was markedly better than the control group ,and there was significant difference between them( P<0 .05) .[Conclusion]Long-term dialysis ,low dialysate flow and low blood flow can significantly re-duce blood pressure ,improve heart function and reverse left ventricular remodeling .Therefore ,it is worthy of further clinical research and promotion .