摘要:
|
目的:研究维持性血液透析(MHD)患者QT间期离散度(QTd)的变化以及透析相关因素对其的影响.方法:46例MHD患者分别于透析前静卧15min及透析后立即记录12导联同步心电图,计算QTd值,同时采取外周血测定生化指标,记录超滤脱水量、超滤率及血压等生理指标.结果:MHD患者透析前QTd明显高于正常对照组(P<0.001),透析后QTd进一步增高(P<0.001);回归分析表明,透析后QTd增幅与透后HCO3-的增高及透析脱水量呈正相关(分别为r=0.53,P<0.001;r=0.56,P<0.001);合并高血压及心室肥厚组QTd分别显著高于非高血压及非心室肥厚组(分别为P<0.05、P<0.01).结论:MHD患者QTd增高,透析使QTd进一步增高,其发生机制与透析脱水及快速纠正酸中毒有关. |
Objective To determine whether changes occur in the QT interval dispersion (QTd) in maintenance hemodialysis patients (MHD) and to assess the effect of hemodialysis on QTd. Methods Serial 12-lead electrocardiogram (ECG) recordings were carried out in 49 MHD patients starting just before a routine dialysis session and ending after dialysis immediately. Plasma electrolyte concentrations, bicarbonate, plasma creatinine, blood pressure, ultrafiltration volume and body weight were assessed before and after each hemodialysis session. Results In MHD patients, QTd was higher than that in control. After the hemodialysis session, we found a significant increase (P<0.001) in QTd and a significant increase in plasma bicarbonate concentration (P<0.001). A correlation was observed between the increase of QTd and the increase of plasma bicarbonate, ultrafiltration volume respectively (r=0.53,P<0.001;r=0.56,P<0.001, respectively). In hypertension subgroup and left ventricular hypertrophy subgroup, QTd was higher than that in patients without hypertension and left ventricular hypertrophy (P<0.05;P<0.01, respectively). Conclusions QTd is significantly increased in MHD patients compared with that in control subjects. Hemodialysis can increase the QTd in patients with terminal-stage renal failure and these changes may be attributed to ultrafiltration and increase of plasma bicarbonate during hemodialysis session. |
参考文献:
|
[1] COLLINS A J. Cardiovascular mortality in end-stage renal disease. 2003
[2] AVRAM M M. How can the cardiac death rate be reduced in dialysis patients?, 2002
[3] ABE S, YOSHIZAWA M, NAKANISHI N. Electrocardiographic abnormalities in patients receiving hemodialysis, 1998
[4] GRUPPO E. Multicentre cross-sectional study of ventricular arrhythmias in chronically haemodialysed patients, 1988
[5] PYE M P, COBBE S M. Mechanism of ventricular arrhythmias in cardiac failure and hypertrophy, 1992
[6] OKIN P M, DEVEREUX R B, HOWARD B V. Assessment of QT interval and QT dispersion for prediction of all-cause and cardiovascular mortality in American Indians:the strong heart study. 2000
[7] BARR C S, NAAS A, FREEMAN M. QT dispersion and sudden unexpected death in chronic heart failure. 1994. doi:10.1016/S0140-6736(94)91164-9
[8] DABROWSKI A, KRAMARZ E, PIOTROWICZ R. Predictive power of increased QT dispersion in ventricular extrasystoles and in sinus beats for risk stratification after myocardial infarction. 2000
[9] PRIORI S G, NAPOLITANO C, DIEHL L. Dispersion of the QT interval:a marker of theraputic efficacy in the idiopathic long QT syndrom, 1994
[10] IATUAN L, JANOS M, ZSOLT Z. QT dispersion in patients with end-stage renal failure and during hemodialysis. 1999
[11] DABROWSKI A, KRAMARZ E, PIOTROWICZ R. Predictive power of increased QT dispersion in ventricular extrasystoles and in sinus beats for risk stratification after myocardial infarction. 2000
[12] BEAUBIEN E R, PYLYPCHUK G B, AKHTAR J. Value of corrected QT interval dispersion in identifying patients initiating dialysis at increased risk of total and cardiovascular mortality. 2002
[13] SCOTT W M, EFTYCHIA G, GRAHAM A S. QT dispersion before and after hemodialysis. 1999
[14] NAPPI S E, VIRTANEN V K, SAHA H H. QTc dispersion increases during hemodialysis with low-calcium dialysate. 2000. doi:10.1046/j.1523-1755.2000.00062.x
[15] YETKIN E, ILERI M, TANDOGAN I. Increased QT interval dispersion after hemodialysis:role of peridialytic electrolyte gradients. 2000. doi:10.1177/000331970005100607
[16] ROMBOLA G, COLUSSI G, ELISABETTA D M. Cardiac arrhythmias and electrolyte changes during hemodialysis, 1992
[17] LEE S, HARRIS N D, ROBINSON R T. Effects of adrenaline and potassium on QTc interval and QT dispersion in man. 2003
[18] ANDERAS P, MICHAELENE O, ROBERT F. Nocturnal hemodialysis:three-year experience, 1998
[19] CHAN C T, MARDIROSSIAN S, FARATRO R. Improvement in lower-extremity peripheral arterial disease by nocturnal hemodialysis. 2003 |
服务与反馈:
|
【文章下载】【发表评论】【查看评论】【加入收藏】
|
提示:您还未登录,请登录!点此登录 |
|
|
copyright ©《东南大学学报(医学版)》编辑部
联系电话:025-83272481 83272483
电子邮件: bjb@pub.seu.edu.cn
苏ICP备09058364
|
|