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目的观察每天短时血液透析(s DHD)对尿毒症患者心脏功能的影响。方法采用序贯治疗法对30例慢性肾功能衰竭患者进行常规血液透析(CHD)治疗2个月后,转为s DHD治疗2个月。观察治疗前后患者的血常规、血清总蛋白(TP)、清蛋白(Alb)及肾功能,计算患者的溶质清除指数(SRI)、时间平均尿素浓度(TACurea),测定患者干体质量(DW),观察透析过程中患者的血压波动情况及四肢抽搐发生率变化,心脏彩色多普勒检查CHD和s DHD治疗前后患者心脏的A峰与E峰流速比值(E/A)和左心室射血分数(LVEF)变化。结果与CHD比较,s DHD治疗2个月后,其反映患者透析充分性的指标SRI和TACurea较治疗前明显改善,患者DW、血清TP、Alb及血红蛋白(Hb)指标较治疗前均明显增加,差异均有统计学意义(P<0.05)。透析低血压、高血压、抽搐发生率及透析后体质量变化较CHD期间明显降低。而反映心脏左心室舒张功能的心脏二尖瓣口血流频谱E/A较治疗前明显减低,E/A<1的患者增多,反映心脏收缩功能的LVEF较治疗前明显增加,差异均有统计学意义(P<0.05)。结论与CHD比较,s DHD能够保证患者透析的充分性,改善患者的营养状况,减少透析相关的急性并发症、改善患者的心功能。
Objective To observe the effect of daily short-term hemodialysis (s DHD) on cardiac function in uremic patients. Methods Thirty patients with chronic renal failure underwent routine hemodialysis (CHD) for 2 months and then treated with s DHD for 2 months. The patients’ blood routine, serum total protein (TP), albumin (Alb) and renal function were observed before and after treatment. Solute clearance index (SRI) and time-average urea concentration (TACurea) , Observed during the dialysis patients with fluctuations in blood pressure and limbs twitch rate changes, heart color Doppler CHD and s DHD before and after treatment in patients with the A peak and E peak flow velocity ratio (E / A) and left ventricular ejection fraction (LVEF) changes. Results Compared with CHD, SRI and TACurea, which reflect the adequacy of dialysis in patients, were significantly improved after treatment with s DHD for 2 months. The indexes of DW, serum TP, Alb and hemoglobin in patients were significantly higher than those before treatment, The differences were statistically significant (P <0.05). Dialysis hypotension, hypertension, twitch incidence and post-dialysis body mass changes were significantly lower than during CHD. The E / A of mitral flow in the mitral valve of left ventricle, which reflects the diastolic function of the heart, was significantly lower than that before treatment. The number of patients with E / A <1 increased, and the LVEF reflecting systolic function increased significantly compared with that before treatment Significance (P <0.05). Conclusion Compared with CHD, s DHD can ensure the adequacy of dialysis, improve the nutritional status of patients, reduce the acute complications related to dialysis and improve the cardiac function of patients.