脉压指数与维持性血液透析患者左心结构及功能的相关性研究

发布时间：2018-05-02 12:26

本文选题：维持性血液透析 + 脉压指数　；参考：《青海大学》2016年硕士论文

【摘要】：目的:探讨维持性血液透析(MHD)患者脉压指数(PPI)与左心结构及功能的相关性并进一步分析左心结构及功能的影响因素。方法:随机收取于2007年1月-2016年2月在青海大学附属医院的肾病内科血液透析中心规律行低通量血液透析治疗的相对完整的患者病历资料共76份,记录患者的人口学资料、生化指标、透析龄(DA)及左心结构及功能指标,记录1个月内所有患者的透析前SBP、DBP、超滤量(UF)、透析间期体重增长百分比(IDWG),计算脉压(PP)、平均动脉压(MAP)、脉压指数(PPI)。采用SPSS 17.0进行统计学分析,探讨脉压指数与左心结构及功能的相关性并进一步分析左心结构及功能改变的影响因素,检验水准为α=0.05。结果:1.LVH组的SBP、PP、PPI、IDWG较非LVH组高,而HGB、TG较非LVH组低,差异有统计学意义(P0.05)。两组间的Age、DA、UF、TP、ALB、GLB、AST、LDH、HBDH、CK、CKMB、MYO、BUN、UA、TCH、LDL、HDL、Ca、P、i PTH、DBP、MAP差异无显著性(P0.05)。2.PP与LA、IVS、LVMI呈显著正相关,差异有统计学意义(P0.05),相关系数从大到小依次为LVMI(0.441)、LA(0.342)、IVS(0.260)。而与LVd、LVPW及左心功能无相关性,差异无统计学意义(P0.05);PPI与LVMI、LA正相关,差异有统计学意义(P0.05),相关系数从大到小分别为LVMI(0.339)、LA(0.276)。与LVd、LVPW、IVS及左心功能无相关性,差异无统计学意义(P0.05)。3.SBP是LVd、IVS、LVPW、LVMI、EDV、SV、CO等左心结构及功能改变的最重要影响因素;HGB是LVMI及CI的重要影响因素;IDWG是LVPW的重要影响因素;PP是LA改变的重要影响因素;PPI虽与LA及LVMI存在正相关,但PPI可能不是导致左心结构及功能改变的影响因素,其与MHD患者心血管事件的相关性主要基于SBP、HGB的变化。结论:1.维持性血液透析患者左室肥厚常见,且左室肥厚者脉压指数高于非左室肥厚者。2.脉压指数与LA、LVMI正相关,可能不是导致左心结构及功能改变的主要影响因素,收缩压是左心结构及功能改变最重要的影响因素。3.控制血压尤其是SBP、减少脉压差、控制透析间期体重增长、改善贫血可能改善MHD患者左心重构及心功能。
[Abstract]:Objective: to investigate the correlation between pulse pressure index (PPI) and left ventricular structure and function in patients with maintenance hemodialysis (MHD) and to analyze the influencing factors of left ventricular structure and function. Methods: a total of 76 patient records were collected randomly from January 2007 to February 2016 in the Nephrology Hemodialysis Center of Qinghai University affiliated Hospital for low-flux hemodialysis. The demographic data of the patients were recorded. Biochemical parameters, age of dialysis (DAA) and left ventricular structure and function were recorded in all patients before dialysis. SBP, UF, IDWGG, average arterial pressure (map), pulse pressure index (PPI) and pulse pressure index (PPI) were recorded in all patients within one month. SPSS 17.0 was used to analyze the correlation between pulse pressure index and left ventricular structure and function, and the influencing factors of left ventricular structure and function were further analyzed. The test level was 伪 0.05. Results 1. In LVH group, the level of LVH / PPIP LVH IDWG was higher than that of non-LVH group, while the level of TG was lower than that of non-LVH group, the difference was statistically significant (P 0.05). There was no significant positive correlation between the two groups (P 0.05.2.PP and LAIVSL LVMI, P 0.05.2.The difference was statistically significant, and the correlation coefficient from large to small was 0.441L 0.342VS0.260.) there was no significant positive correlation between the two groups (P 0.05.2.The difference was statistically significant) between the two groups, and the correlation coefficient from big to small was: MI0.441L0.342IVS0.2600.The difference between the two groups was not significant (P0.05.2.The difference between PP and LAIVSLVMI was statistically significant, and the correlation coefficient from big to small was as follows: MI0.441L0.342VS0.260nil.) the difference between the two groups was not significant (P 0.05.2.PP and LAIVSL LVMI) were significantly higher than those in the control group. There was no significant correlation between LVPW and LVPW and left ventricular function, but there was no significant difference between P0.05PPI and LVMILA. There was no correlation between LVD and LVPWV IVS and left ventricular function. There was no significant difference between them (P 0.05). 3. SBP was the most important factor influencing the structure and function of left heart, such as LVDIVS, LVMI, EDV, LVMI, etc. HGBwas an important factor of LVMI and CI. LVPW was an important influencing factor. PP was an important influencing factor of LA, although there was a positive correlation between PPI and LA and LVMI. However, PPI may not be the influencing factor for the changes of left ventricular structure and function, and its correlation with cardiovascular events in patients with MHD is mainly based on the changes of SBP / HGB. Conclusion 1. Left ventricular hypertrophy is common in maintenance hemodialysis patients, and the pulse pressure index in patients with left ventricular hypertrophy is higher than that in non-left ventricular hypertrophy patients. Pulse pressure index was positively correlated with LVMI, which may not be the main influencing factor for the change of left ventricular structure and function, and systolic pressure was the most important factor for the change of left ventricular structure and function. Control of blood pressure, especially SBP, reduction of pulse pressure difference, control of weight gain during dialysis period, improvement of anemia may improve left ventricular remodeling and cardiac function in patients with MHD.
【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R459.5

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