摘要
目的了解终末期肾病(end-stage renal disease,ESRD)患者血液透析(hemodialysis,HD)过程中的心率变异性(heart rate variability,HRV)的变化及其与低血压的关系。方法入选规律行HD3个月以上的27例ESRD患者(HD组)及30例健康人(正常对照组)。进行HD患者透析过程中及健康人24h动态心电图监测。比较两组HRV的不同及HD组患者HRV的变化及与低血压的关系,分析引起该变化的相关因素。结果 HD组27例患者中单独的副交感神经活性受损者占51.9%,单独的交感神经受损者占3.7%,副交感与交感神经同时受损者占3.7%。与正常对照组相比,HD组患者透析前标化后低频(nLF)及低频/高频(LF/HF)升高,标化后高频(nHF)降低(均P<0.05);R-R间期标准差(SDNN)、相邻两个正常心动周期差值>50ms的心搏数占总心搏数百分比(pNN50)及三角指数(TI)均显著降低(均P<0.05)。HD组透析中出现低血压的患者,基础及透析过程中nLF较高,而nHF较低,发生低血压时nHF显著增加(P<0.05)。左心室射血分数(EF)是△LF%的独立影响因素。结论 ESRD患者心脏自主神经功能受损,表现为副交感神经活性减弱及交感神经活性增强。在HD过程中,低血压患者表现出明显的心脏自主神经调节功能受损,无法代偿快速体液丢失的反应。左心室EF是影响透析过程中交感神经活性变化的独立危险因素。
Objective To investigate the change of heart rate variability （HRV） in end-stage renal disease （ESRD） patients during hemodialysis （HD） and the relationship between the change of HRV and intra-dialytic hypotension, Methods This study consisted of 27 ESRD patients on maintenance HD for more than 3 months as well as 30 healthy controls. Dynamic electrocardiography （Holter） was conducted in HD patients during hemodialysis, and 24-hour Holter electrocardiography was performed in controls. We then analyzed and the difference in HRV between patients and healthy controls, the HRV change relating to intra-dialytic hypotension, and the factors affecting HRV change in HD patients. Results （a） Abnormal parasympathetic activity was found in 51.9% ESRD patients, abnormal sympathetic activity in 3.7% patients, and combined parasympathetic and sympathetic abnormalities in 3.7% patients. （b） In ERSD patients compared with the controls, low frequency （LF） and low frequency/high frequency （LF/HF） were significantly elevated, whereas high frequency （HF）, SDNN, pNN50 and TI were signifi- cantly reduced （P 〈0.05）. （c） The patients with intra-dialytic hypotension had higher normalized LF （nLF） and lower normalized HF （nHF） before and during HD than those without hypotension （P 〈0.05）. The nHF was higher when hypotension happened than before HD. （d） Ejection fraction was an independent factor for A LF%. Conclusions ESRD patients have dysfunction in autonomic nervous system, involving decrease of parasympathetic activ- ity and increase of sympathetic activity. During HD, the patients with intra-dialytic hypotension usually have serious dysfunction in autonomic nervous system, resulting in the decompensation to rapid loss of body fluid. Left ventricle ejection fraction is an independent risk factor for change of sympathetic activity during HD.
出处
《中国血液净化》
2010年第11期594-598,共5页
Chinese Journal of Blood Purification
关键词
心率变异性
终末期肾病
血液透析
低血压
Heart rate variability
End-stage renal disease
Hemodialysis
Hypotension
