脉冲波组织多普勒超声心动图评价单次血液透析治疗对终末期肾病患者左室功能的急性影响

目的 评价单次血液透析(HD)治疗对终末期肾病(ESRD)患者左室功能的急性影响.方法 57例既往无心血管疾病病史,且正处于维持性HD治疗中的ESRD患者入选本研究.所有患者于单次HD治疗前及治疗后1 h内接受超声心动图检查.常规超声心动图测量并分析左室形态及功能指标.脉冲波组织多普勒成像(PW-TDI)测量二尖瓣环运动速度.结果 单次HD治疗后,左室内径明显减小(P<0.05);PW-TDI及常规超声心动图左室收缩功能指标,包括二尖瓣环等容收缩期峰值速度(IVS)、收缩期峰值速度(Sm)及左室射血分数(LVEF)均较治疗前显著升高(P<0.05).常规超声心动图左室舒张功能指标,包括二尖瓣血流舒张早期峰值流速(E)、舒张晚期峰值流速(A)及E/A比值,较单次HD治疗前均明显减低(P<0.05);而PW-TDI左室舒张功能指标,包括二尖瓣环舒张早期峰值速度(Em)、舒张晚期峰值速度(Am)及Em/Am比值则未见显著变化.左室充盈压相关指标E/Em比值在单次HD治疗后显著降低(P<0.05).结论 单次HD治疗可以改善ESRD患者左室收缩功能;PW-TDI技术可以在不同的前负荷状态下准确地评价左室舒张功能.

Acute effects of a single hemodialysis session on global left ventricular function in patients with end-stage renal disease with pulsed-wave tissue Doppler echocardiography

Objective To detect the acute effects of a single hemodialysis (HD) session on left ventricular (LV) function in patients with end-stage renal disease (ESRD) on maintenance HD therapy using pulsed-wave tissue Doppler imaging (PW-TDI). Methods Fifty-seven patients underwent echocardiography 1 h prior to and 1 h following regular HD. Two-dimensional and Doppler echocardiography were used to analyze conventional LV structural and functional parameters. Systolic and diastolic mitral annular velocities assessed by PW-TDI. Results After HD, the size of LV significantly reduced. Parameters of LV systolic function-ejection fraction and systolic mitral annular velocity were significantly improved. As for LV diastolic function, conventional Doppler parameters were substantially decreased after HD, while PW-TDI diastolic velocities did not change significantly. And the ratio of E/Em also decreased after a single HD session. Conclusion A single HD session can improve the global LV systolic function. The LV diastolic function can be evaluated accurately with PW-DTE in the different LV preload conditions.