不同血管通路选择对维持性血液透析患者心功能的影响及预后影响因素研究

发布时间：2019-02-08 19:59

【摘要】：目的比较选择动静脉内瘘与长期导管对维持性血液透析患者心功能的变化,探讨预后的影响因素。方法选取2010—2012年于天津医科大学第二医院进行维持性血液透析的患者219例为研究对象,根据维持性血液透析采用的血管通路,将患者分为动静脉内瘘组(109例)和长期导管组(110例)。收集患者一般资料,记录尿素清除率(Kt/V),采用超声心动图检查患者左心室功能,记录两组患者入组后1年内的死亡情况及死亡原因。结果两组患者舒张压(DBP)、血红蛋白(Hb)水平、原发疾病构成比较,差异均有统计学意义(P0.05)。两组Kt/V比较,差异无统计学意义(P0.05)。动静脉内瘘组患者左心室肥厚、收缩功能障碍发生率高于长期导管组(P0.05)。动静脉内瘘组心血管事件病死率(4.6%,5/109)与长期导管组(63.6%,7/110)比较,差异无统计学意义(χ2=0.334,P=0.564)。多因素Cox比例风险回归模型分析显示,收缩压〔HR=0.991,95%CI(0.981,0.999)〕、DBP〔HR=0.981,95%CI(0.966,0.988)〕、血钙〔HR=2.240,95%CI(1.042,6.321)〕、甲状旁腺激素〔HR=1.004,95%CI(1.001,1.022)〕水平是维持性血液透析患者发生心血管事件死亡的影响因素(P0.05)。结论通过动静脉内瘘进行维持性血液透析患者更易发生左心室功能异常,对维持性血液透析患者控制血压水平、维持正常血钙水平、降低PTH水平均可能有助于改善长期预后。
[Abstract]:Objective to compare the effects of arteriovenous fistula and long-term catheter on cardiac function in maintenance hemodialysis patients and to explore the prognostic factors. Methods 219 patients undergoing maintenance hemodialysis in the second Hospital of Tianjin Medical University from 2010 to 2012 were selected as subjects. The patients were divided into arteriovenous fistula group (109 cases) and long term catheter group (110 cases). General data of patients were collected, urea clearance rate (Kt/V) was recorded, left ventricular function was examined by echocardiography, death and causes of death were recorded in two groups within one year after entering the group. Results the (Hb) level of (DBP), hemoglobin and the constitution of primary disease were significantly different between the two groups (P0.05). There was no significant difference in Kt/V between the two groups (P0.05). The incidence of left ventricular hypertrophy and systolic dysfunction in arteriovenous fistula group was higher than that in long term catheter group (P0.05). The mortality rate of cardiovascular events in arteriovenous fistula group (4.6 / 109) was not significantly different from that in long term catheter group (63.6 / 7 / 110) (蠂 ~ 2 / 0.334 / P ~ (0.564). Multivariate Cox proportional risk regression analysis showed that systolic blood pressure (HR=0.991,95%CI) (HR=0.991,95%CI (0.981U 0.999), DBP (HR=0.981,95%CI) (0.966V 0.988), calcium (HR=2.240,95%CI (1.042 卤6.321),) The level of parathyroid hormone (HR=1.004,95%CI (1.001 卤1.022) was the influencing factor of cardiovascular death in maintenance hemodialysis patients (P0.05). Conclusion patients undergoing maintenance hemodialysis through arteriovenous internal fistula are more likely to have abnormal left ventricular function, which may help to improve long-term prognosis of patients with maintenance hemodialysis by controlling blood pressure level, maintaining normal blood calcium level and lowering PTH level.
【作者单位】：天津医科大学第二医院肾脏病血液净化科;
【基金】：天津市卫生行业2012年重点攻关项目(12KG136)
【分类号】：R459.5

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