MHD患者超声心动图表现及相关临床分析

发布时间：2018-02-23 00:12

本文关键词： 维持性血液透析超声心动图心脏结构和功能改变透析前后透析龄　出处：《天津医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：研究目的应用超声心动图评价血液透析患者心脏结构及功能的改变；观察透析前后心脏结构及功能的差异,分析其原因；探讨透析患者心脏结构及功能随透析龄增加的变化趋势。研究方法对塘沽中医院血液透析室被选取的54例维持性血液透析患者及42例门诊健康查体者的超声心动图检查数据进行收集整理。首先,通过对研究组与对照组心脏腔室大小、室壁厚度、左室的收缩舒张功能以及肺动脉收缩压的观察比较,从整体上评价血液透析患者心脏结构及功能的改变；然后,将研究组数据按透析前、透析后分组,观察透析前后心脏结构及功能的差异,探讨其原因；最后,以透龄30月为界将研究组分为低透龄组、高透龄组,结合对照组探讨透析患者心脏结构及功能随透龄增加的变化趋势。研究结果 1.研究组透析后的心脏结构及功能与对照组比较,各腔室内径增大,室间隔增厚,每博量、心率、心输出量、肺动脉收缩压增加,左室射血分数、E/A比值减小(P0.05)。 2.研究组透析后的心脏结构及功能与透析前进行比较,各腔室内径减小,室间隔增厚,每博量、心输出量、射血分数、肺动脉收缩压减低,心率、左室E/A比值增加(P0.05)。 3.随着透析龄的增加,各腔室内径增大,室间隔增厚,E/A比值减低,每博量、肺动脉收缩压增高(P0.05)；心输出量研究组较对照组增加(P0.05),高透龄组与低透龄组比较无明显差异(P0.05)。研究结论 1.维持性血液透析患者心脏腔室增大,尤以左房、左室明显,伴随着左室壁的肥厚；同时,左室的收缩及舒张功能减低、肺动脉收缩压的增高。 2.透析前、透析后的超声心动图表现存在显著差异,但均是患者心脏结构及功能状态的客观反映,透析过程中体内过多的水分及毒素的滤出是其主要原因。 3.维持性血液透析患者心脏结构及功能的改变是个长期的、多因素综合作用的结果。随着透析龄的增加,透析患者心脏功能受损呈逐渐加重的趋势。 4.超声心动图检查具有经济安全、实时动态成像优势,可定量或半定量的检测透析患者的心脏结构和功能状态。
[Abstract]:Research purpose. Echocardiography was used to evaluate the changes of cardiac structure and function in hemodialysis patients, to observe the difference of cardiac structure and function before and after dialysis, to analyze the causes, and to explore the changing trend of cardiac structure and function with the age of dialysis. Research method. The echocardiographic data of 54 maintenance hemodialysis patients and 42 outpatient health examiners in the hemodialysis room of Tanggu Chinese Medicine Hospital were collected and sorted. Firstly, the size of the heart chamber in the study group and the control group was analyzed. Ventricular wall thickness, left ventricular systolic and diastolic function and pulmonary systolic pressure were observed and compared to evaluate the changes of cardiac structure and function in hemodialysis patients. The difference of cardiac structure and function before and after dialysis was observed and the causes were discussed. Finally, the study group was divided into low permeability group and high permeable age group by 30 months of dialysis. The changes of cardiac structure and function with the age of dialysis were investigated in the control group. Research results. 1.Compared with the control group, the cardiac structure and function of the study group after dialysis, the diameter of each chamber increased, the ventricular septum thickened, the heart rate, heart rate, cardiac output, pulmonary systolic pressure increased, and the left ventricular ejection fraction (LVEF) / E / A ratio decreased (P 0.05). 2. The cardiac structure and function after dialysis in the study group were compared with those before dialysis. The diameter of each chamber decreased, the ventricular septum thickened, the cardiac output, ejection fraction, pulmonary systolic pressure decreased, heart rate and left ventricular E / A ratio increased P0.05. 3. With the increase of dialysis age, the diameter of each chamber increased, the ratio of E / A of ventricular septal thickening decreased, and the systolic pressure of pulmonary artery increased (P 0.05). The cardiac output in the study group was higher than that in the control group (P 0.05), but there was no significant difference between the hyperosmotic age group and the low permeation age group (P 0.05). Research conclusion. 1. In maintenance hemodialysis patients, the cardiac lumen increased, especially in left atrium and left ventricle, accompanied by the hypertrophy of left ventricular wall, at the same time, the systolic and diastolic function of left ventricle decreased and the systolic pressure of pulmonary artery increased. 2. There were significant differences in echocardiography before and after dialysis, but it was the objective reflection of the cardiac structure and function of the patients. The main reason was the excessive water and toxin filtration in the body during dialysis. 3. The change of cardiac structure and function in maintenance hemodialysis patients is a long-term, multi-factor comprehensive result. With the increase of dialysis age, the cardiac function damage of dialysis patients is gradually aggravated. 4. Echocardiography has the advantages of economic safety, real-time dynamic imaging, quantitative or semi-quantitative detection of cardiac structure and function in dialysis patients.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692.5;R540.45

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