CAJ | 학술논문

目的：探讨长期动静脉内瘘对非糖尿病肾病血液透析患者血液动力学及心脏结构和功能的影响。方法将2011~2013年肾内科收治的非糖尿病肾病血液透析患者100例，按动静脉内瘘流量（Qa）分为三组。对其进行回顾性分析研究，采用超声稀释法检测心脏搏出量、心输出量（CO）、外周血管阻力等血液动力学指标，并与血液透析次日行心脏彩色超声心动图检测，分析动静脉 Qa 对血液动力学及心脏结构和功能的影响。结果 Qa >2.0 L/ min 组在内瘘流量、Qa/CO、搏出量、心脏输出量、心脏指数、中心血容量方面明显高于其他两组，外周血管阻力明显低于其他两组，差异均有统计学意义（ P 均<0.05）；Qa 0.6~2.0 L/ min 组内瘘流量、Qa/ CO、搏出量均高于 Qa <0.6 L/ min 组，差异有统计学意义（ P <0.05），而在心脏指数、中心血容量、外周血管阻力方面差异无统计学意义（ P >0.05）；左房直径、右房面积、右房直径、右房面积、左室后壁厚度、室间隔厚度、LEVSD、LEVDD 的指标随着 Qa 的增加而增大，且右房面积、LEVSD、LEVDD 指标在 Qa >2.0 L/ min 组和 Qa <0.6 L/ min 组间差异有统计学意义（ P <0.05）；心脏功能方面 Qa >2.0 L/ min 组明显低于 Qa <0.6 L/min 组、Qa 0.6~2.0 L/ min 组，差异有统计学意义（ P <0.05）。结论长期 AVF 对血液动力学及心脏结构和功能与 Qa 有关，当流量控制在一定范围内时心脏变化以代偿性改变为主，当 Qa >2.0 L/ min 出现心腔明显扩大的可能性比较大，易出现心衰并发症，因此临床上应根据患者病情选择合适的流量。
목적：탐토장기동정맥내루대비당뇨병신병혈액투석환자혈액동역학급심장결구화공능적영향。방법장2011~2013년신내과수치적비당뇨병신병혈액투석환자100례，안동정맥내루류량（Qa）분위삼조。대기진행회고성분석연구，채용초성희석법검측심장박출량、심수출량（CO）、외주혈관조력등혈액동역학지표，병여혈액투석차일행심장채색초성심동도검측，분석동정맥 Qa 대혈액동역학급심장결구화공능적영향。결과 Qa >2.0 L/ min 조재내루류량、Qa/CO、박출량、심장수출량、심장지수、중심혈용량방면명현고우기타량조，외주혈관조력명현저우기타량조，차이균유통계학의의（ P 균<0.05）；Qa 0.6~2.0 L/ min 조내루류량、Qa/ CO、박출량균고우 Qa <0.6 L/ min 조，차이유통계학의의（ P <0.05），이재심장지수、중심혈용량、외주혈관조력방면차이무통계학의의（ P >0.05）；좌방직경、우방면적、우방직경、우방면적、좌실후벽후도、실간격후도、LEVSD、LEVDD 적지표수착 Qa 적증가이증대，차우방면적、LEVSD、LEVDD 지표재 Qa >2.0 L/ min 조화 Qa <0.6 L/ min 조간차이유통계학의의（ P <0.05）；심장공능방면 Qa >2.0 L/ min 조명현저우 Qa <0.6 L/min 조、Qa 0.6~2.0 L/ min 조，차이유통계학의의（ P <0.05）。결론장기 AVF 대혈액동역학급심장결구화공능여 Qa 유관，당류량공제재일정범위내시심장변화이대상성개변위주，당 Qa >2.0 L/ min 출현심강명현확대적가능성비교대，역출현심쇠병발증，인차림상상응근거환자병정선택합괄적류량。
Objective To investigate the influence on hemodynamic and cardiac structure and function of long - term arteriovenous fistula for hemodialysis non - diabetic nephropathy. Methods 60 cases with non - diabetic nephropathy hemodialysis were selected from nephrology during the period from 2011 to 2013. They were divided into three groups pressing arteriovenous fistula flow. Retrospective analysis was performed in these inde-xes,including cardiac stroke volume,cardiac output,peripheral vascular resistance and other hemodynamic indices detected in dilution method using ultrasound. Echocardiography was performed to detect the cardiac function,to analyze the flow of arteriovenous fistula to hemodynamics and cardiac structure and function. Results Fistula flow,Qa/ CO,stroke volume,cardiac output,cardiac index,central blood volume,peripheral vascular re-sistance of Qa > 2. 0 L/ min group had statistically significant compared the other two groups( P <0. 05). Fistula flow,Qa/ CO,stroke volume of Qa 0. 6 ~2. 0 L/ min group were higher than those of Qa <0. 6 L/ min group. The difference was statistically significant( P <0. 05). Cardiac index, central blood volume,peripheral vascular resistance had no statistically significant( P >0. 05). Left atrial diameter,right atrial area,right atrial di-ameter,right atrial size,left ventricular wall thickness,ventricular septal thickness,LEVSD,LEVDD increased with the increasing of Qa,right atri-al area,LEVSD,LEVDD in Qa > 2. 0 L/ min group and Qa <0. 6 L/ min group. These indexes had statistically significant( P <0. 05). Cardiac function of Qa > 2. 0 L/ min group had statistically significant difference,compared with Qa <0. 6 L/ min group,Qa 0. 6 ~2. 0 L/ min group( P <0. 05). Conclusion Long - term AVF to hemodynamics,cardiac structure and function had relationship with Qa,changed in heart compensatory changes when the flow control within a certain range. The heart chamber had significant expansion when Qa > 2. 0 L/ min,which was prone to com-plications of heart failure,therefore should select the appropriate flow rate based on the patient′s condition clinically.