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目的探讨不同方式血管通路血液透析对肺动脉压的影响以及影响肺动脉压升高的相关危险因素。方法对73例维持性血液透析患者采用多普勒超声心动图三尖瓣返流压差法检测三尖瓣最大返流速度,根据Bernoulli简化方程计算出三尖瓣返流压差和肺动脉压,采用多元logistic回归比较维持性血液透析患者肺动脉高压的相关危险因素。结果本组维持性血液透析患者超声心动图诊断肺动脉压升高23例(占31.5%),动静脉内瘘组17例(42.5%),中心静脉导管6例(18.2%);动静脉内瘘组肺动脉返流压(15.17±8.51mmHg)与中心静脉导管组(10.04±6.14mmHg)比较(P<0.01)。结论使用中心静脉导管的血液透析患者肺动脉高压相对危险性低于动静脉通路进行血液透析者;不同方式血管通路、血红蛋白水平和营养不良(低白蛋白血症)是影响肺动脉高压的相关危险因素。
Objective To investigate the effect of different modalities of hemodialysis on pulmonary arterial pressure and related risk factors of pulmonary hypertension. Methods The maximum tricuspid regurgitation velocity was measured in 73 patients with maintenance hemodialysis by tricuspid regurgitation by Doppler echocardiography. The tricuspid regurgitation pressure and pulmonary pressure were calculated according to Bernoulli’s simplified equation. Multivariate logistic regression was used to compare the risk factors associated with pulmonary hypertension in maintenance hemodialysis patients. Results Echocardiography of maintenance hemodialysis patients were diagnosed pulmonary hypertension in 23 cases (31.5%), arteriovenous fistula in 17 cases (42.5%), central venous catheter in 6 cases (18.2%), arteriovenous fistula Pulmonary artery regurgitation pressure (15.17 ± 8.51mmHg) compared with the central venous catheter group (10.04 ± 6.14mmHg) (P <0.01). Conclusions Hemodialysis patients with central venous catheters are at a lower risk of pulmonary hypertension than arteriovenous access; hemodialysis patients with different modalities of vascular access, hemoglobin levels and malnutrition (hypoalbuminemia) are associated risk factors for pulmonary hypertension.