| 摘要: |
| 目的 应用超声心动图评价慢性肾功能衰竭患者血液透析前后右心室容量和心肌力学参数变化情况。
方法 选取经临床确诊为慢性肾功能衰竭并行血液透析的患者100例，于血液透析前后行超声心动图检测并比较三尖瓣侧壁瓣环收缩期位移（TAPSE）、右心室面积变化分数（RV FAC）及收缩期二维右心室游离壁峰值应变（2D RVFWLS），组织多普勒测量舒张期三尖瓣环运动速度（e、a）和收缩期三尖瓣反流峰值速度（TRmax），并将上述参数与透析超滤量进行相关性分析。
结果 血液透析后患者体质量为（61.01±9.77）kg，较透析前[（63.04±9.88）kg]明显减低，差异有统计学意义（P＜0.05）；透析后肱动脉收缩压和舒张压与透析前比较差异均无统计学意义。透析后TAPSE为（21.36±2.35）mm，较透析前[（20.23±2.30）mm]增加，差异有统计学意义（P＜0.05）；透析前后RV FAC、2D RVFWLS、e/a和TRmax比较，差异均无统计学意义。透析后肱动脉舒张压与超滤量具有相关性（r=0.304，P=0.002）；透析后TAPSE、RV FAC、2D RVFWLS、e/a和TRmax均与超滤量无相关性（r=0.007、-0.191、-0.046、-0.019、-0.019）。
结论 TAPSE与右心室容量负荷（前负荷）改变有关。血液透析后TAPSE较透析前显著增大，提示血液透析可增强右心室游离壁纵向收缩功能，但与血液透析超滤量无关。透析超滤量影响肱动脉舒张压。 |
| 关键词: 超声心动描记术 肾功能衰竭，慢性 血液透析 心室功能，右 |
| DOI： |
| 投稿时间：2018-02-02修订日期：2018-03-21 |
| 基金项目: |
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| Assessment of right ventricular function in patients with chronic renal failure before and after hemodialysis using echocardiography |
| liuhongtao,wangzhigang |
| () |
| Abstract: |
| Objective To evaluate the changes of right ventricular volume and myocardial mechanical parameters before and after hemodialysis in patients with chronic renal failure using echocardiography. Methods One hundred patients with clinically diagnosed chronic renal failure underwent hemodialysis were enrolled in the study.Conventional and tissue Doppler （TDI）echocardiography was performed before and after hemodialysis immediately and respectively to measure tricuspid annular plane systolic excursion（TAPSE）,right ventricular fractional area change（FAC）,the longitudinal two-dimensional right ventricular free wall systolic peak strain（2D RVFWLS）,diastolic velocity（e,a） of tricuspid annulus at free wall ,systolic peak velocity of tricuspid regurgitation（TRmax）for the differences and the correlation between the above parameters and the amount of ultrafiltration volume. Results The weight of patients was significantly reduced after dialysis（61.01±9.77vs.63.04±9.88, P＜0.05）.There were no statistically significant difference of systolic and diastolic blood pressures of brachial artery before and after dialysis .There was a significant increment of TAPSE after dialysis compared to that before dialysis （21.36±2.35 vs. 20.23±2.30, P＜0.05）.There was no statistically significant changes in FAC （%）, 2D RVFWLS, e/a（%）, TRmax （42.41±9.08,15.09±9.58,64.20±25.99,1.62±0.54vs.40.98±8.48,14.65±9.20,62.47±22.17,1.62±0.51, P＞0.05）.The brachial artery diastolic blood pressure after dialysis was statistically correlated with ultrafiltration volume（r=0.304,P=0.002）.There was no correlation between TAPSE, RVFAC, 2DRVFWLS, e/a and TRmax after dialysis to the ultrafiltration volume（r=0.007,-0.191,-0.046,-0.019,-0.019,P＞0.05）. Conclusion TAPSE is correlated with the right ventricular volume load（pre-load）. The increased TAPSE significantly after hemodialysis than that before dialysis suggests that hemodialysis could enhance the longitudinal systolic function of right ventricular free wall, but not correlated with the volume of hemodialysis ultrafiltration. The ultrafiltration volume might impact on the brachial artery diastolic blood pressure. |
| Key words: chronic renal failure hemodialysis right ventricular function echocardiography |
