CAJ | 학술논문

目的探讨肾移植术前不同血液透析时间对原发性肾小球肾炎尿毒症患者心脏结构与功能的影响.方法根据肾移植术前是否血液透析和不同血液透析时间对206例原发性肾小球肾炎尿毒症患者进行分组:透析龄≤1年(90例)、透析龄≤3年(77例)、透析龄>3年(39例)共3组,应用超声心动图测量3组患者肾移植前、肾移植后1个月和3个月的左心室结构和功能的参数,并进行比较.结果肾移植术后患者左心收缩及舒张功能均有降低趋势;心脏各房、室腔均有不同程度缩小,室间隔和室壁搏幅增加,厚度变薄,左心室短轴缩短率、左心室射血分数等心功能测值较肾移植术前明显改善,扩大的左心房、左心室较肾移植术前缩小.尤其术前透析龄≤1年组患者,心肌和心脏明显缩小.肾移植术后二尖瓣口舒张早期血流峰值流速升高,舒张晚期峰值流速降低,E/A比值升高,E峰减速时间及等容舒张时间明显缩短.透析龄≤1年、透析龄≤3年、透析龄>3年的患者术前、术后1个月、术后3个月左心房收缩末期内径、左心室舒张末期内径、左心室收缩末期内径、室间隔厚度、左心室后壁厚度、左心室短轴缩短率、左心室射血分数、二尖瓣E峰最大流速、二尖瓣A峰最大流速、E/A比值、E峰减速时间、左心室等容舒张时间比较,差异均有统计学意义(P<0.01);透析龄≤1年的患者分别与透析龄≤3年、透析龄>3年组患者比较,各参数间差异均有统计学意义(P <0.01).结论随血液透析时间的延长,原发性肾小球肾炎尿毒症患者心脏结构和功能均逐渐发生变化,应尽可能缩短肾移植术前血液透析时间,避免透析时间多于1年,以提高长期存活率,减少术后并发症的发生率.
목적탐토신이식술전불동혈액투석시간대원발성신소구신염뇨독증환자심장결구여공능적영향.방법근거신이식술전시부혈액투석화불동혈액투석시간대206례원발성신소구신염뇨독증환자진행분조:투석령≤1년(90례)、투석령≤3년(77례)、투석령>3년(39례)공3조,응용초성심동도측량3조환자신이식전、신이식후1개월화3개월적좌심실결구화공능적삼수,병진행비교.결과신이식술후환자좌심수축급서장공능균유강저추세;심장각방、실강균유불동정도축소,실간격화실벽박폭증가,후도변박,좌심실단축축단솔、좌심실사혈분수등심공능측치교신이식술전명현개선,확대적좌심방、좌심실교신이식술전축소.우기술전투석령≤1년조환자,심기화심장명현축소.신이식술후이첨판구서장조기혈류봉치류속승고,서장만기봉치류속강저,E/A비치승고,E봉감속시간급등용서장시간명현축단.투석령≤1년、투석령≤3년、투석령>3년적환자술전、술후1개월、술후3개월좌심방수축말기내경、좌심실서장말기내경、좌심실수축말기내경、실간격후도、좌심실후벽후도、좌심실단축축단솔、좌심실사혈분수、이첨판E봉최대류속、이첨판A봉최대류속、E/A비치、E봉감속시간、좌심실등용서장시간비교,차이균유통계학의의(P<0.01);투석령≤1년적환자분별여투석령≤3년、투석령>3년조환자비교,각삼수간차이균유통계학의의(P <0.01).결론수혈액투석시간적연장,원발성신소구신염뇨독증환자심장결구화공능균축점발생변화,응진가능축단신이식술전혈액투석시간,피면투석시간다우1년,이제고장기존활솔,감소술후병발증적발생솔.
Objective To compare the structure and function of left ventricular before and after renal transplantation .To discover the effect of kidney transplantation based on different dialysis duration . Methods Two handred six pre-renal transplants were assigned into 3 groups based on the dialysis duration:group A, non-dialyzed group,≤1 year group (90 cases); group B, ≤3 years group (77 cases);group C,>3 years group (39 cases).The structure and function of left ventricular was evaluated 1 and 3 months after kidney transplantation using Echocardiography .Results The echocardiographic results of all 3 groups showed decrease of the heart chambers , the thickness of interventricular septum and left ventricular posterior wall.The left ventricular short axis shorten rate and the left ventricular ejection fraction improved .For patients with no dialysis or less than 1 year, the heart size decreased significantly .The early diastolic peak velocity of mitral valve increased, the late diastolic peak velocity decreased , the E/A value rose, the E peak deceleration time and the isovolumic relaxation time shorten remarkably .The left ventricular structure and function improvement of pre-transplant, 1 month and 3 months after transplant in group A was more significant than that in group B and C(P<0.01).Conclusions The structure and function of left ventricular change gradually with the extended dialysis duration before renal transplantation .Shorten the dialysis duration to less than 1 year would be beneficial to prolonged survival rate and reduced incidence of renal transplant complication .