影响终末期肾衰竭患者心脏扩大的因素

目的了解成都铁路分局医院血液进化中心终末期肾衰竭并维持性血液透析患者心脏扩大的影响因素,以便提高患者的血液透析质量和生存率。方法回顾本血液净化中心收治的216例终末期肾衰竭并维持性血液透析2月以上患者,根据心脏彩色多普勒检查,分为心脏扩大与心脏未扩大2组,对可能影响心脏扩大的因素:年龄、血液透析病程、每周血液透析时间、高血压、容量超负荷、血红蛋白水平、低蛋白血症等用SPSS10.0软件作Logistic回归分析。结果终末期肾衰竭并维持性血液透析患者216例,心脏扩大者183例,未扩大者33例,心脏扩大的发生率为84.72%。心脏扩大与容量超负荷呈显著正相关,P=0.002,OR值42.619;心脏扩大与高血压呈正相关,P=0.026,OR值15.353;心脏扩大与血红蛋白水平呈负相关,P=0.043,OR值0.934。心脏扩大与年龄、血液透析病程、每周血液透析时间和低蛋白血症无相关关系。结论终未期肾衰竭并维持性血液透析患者心脏扩大发生率高,而容量超负荷、高血压、血红蛋白水平是影响它的关键,高血压及容量超负荷是促进心脏扩大的独立危险因素,血红蛋白水平下降亦是促进心脏扩大的独立危险因素。

The risk factor of cardiac dilatation in the patients with end stage renal disease

Objective To find out the factors influencing cardiac dilatation in the patients with end stage renal disease(ESRD) undergoing maintenance hemodialysis in our blood purification centre and to improve the quality of hemodialysis and survival rate.Methods The 216 patients with ESRD undergoing maintenance hemodialysis(>2 months) in our blood purifi-cation centre were retrospectively analysed. These patients were divided into cardiac dilata-tion group and whitout cardiac dilatation group according to Color Doppler ultrasonography results.The probable factors of cardiac dilatation are age,course of hemodialysis,times of hemodialysis weekly, hypertension,volume overload,hemoglobin levels,hypoproteinemia and so on. We porformed logistic regressive analysis on above factors with SPSS10.0 software.Results One hundred and eighty-three patients had cardiac dilatation and 33 patients not in 216 patients with ESRD undergoing maintenance hemodialysis,the incidence of cardiac dilatation was 84.72%. The cardiac dilatation had positive correlation with volume overload,(P =0.002, OR value was 42.619)and hypertension,(P =0.026, OR value was 15.353). The cardiac dilatation had negative corretation with hemoglobin levels,(P =0.043,OR value was 0.934).The cardiac dilatation had no correlation with age,course of hemodialysis,times of hemodialysis weekly and hypoproteinemia. Conclusions The incidence of cardiac dilatation in the patients with ESRD undergoing maintenance hemodialysis is high.Volume overload,hypertension,low hemoglobin levels are main risk factors leading to cardiac dilatation.