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題 名 | Adjusting Ultrafiltration in Hypertensive Hemodialysis Patients=高血壓血液透析病人血液透析中超過濾脫水的調節 |
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作 者 | 曾黃泱; 陳逸洲; 吳志仁; 陳漢湘; | 書刊名 | 臺灣腎臟醫學會雜誌 |
卷 期 | 23:2 2009.06[民98.06] |
頁 次 | 頁79-83+125 |
分類號 | 415.816 |
關鍵詞 | 血液透析; 超過濾脫水; 細胞外體液容積; 左心室質量指數; 舒張期左心室內徑寬; Hemodialysis; Ultrafiltration; Extracellular volume; ECV; Left ventricular mass index; LVMI; Left ventricular internal diameter in diastole; LVIDd; |
語 文 | 英文(English) |
中文摘要 | 背景:血液透析病人中體液過剩是造成高血壓及左心室肥大的主要原因。血液透析中超過濾脫水(ultrafiltration)可以改善病人的左心室肥大及降低心臟衰竭的發生。調節血液透析中超過濾脫水是很重要的。方法:我們選取七十四位正常人當做對照組及三十七位穩定慢性高血壓血液透析病人,分析左心室質量指數(LVMI)、年齡、血比容、副甲狀腺賀爾蒙(intact PTH)、接受血液透析治療時間(duration)、身高、體重和細胞外體液容積比(ECV%)間的相關性。我們同時分析細胞外體液容積比和舒張期左心室內徑寬(LVDd)(left ventricular internal diameter in diastole)、左心室後壁厚度(PWTd)(posterior wall thickness in diastole)和心室間隔厚度(IVSTd)(interventricular septal thickness in diastole)間的相關性。細胞外體液容積(ECV)過剩的病人,我們經由增加超過濾脫水(ultramtration)降低病人的乾體重(dry weight),並且在一年後重新評估病人的細胞外液容積比及心臟超音波上的變化。結果:在女性,細胞外體液容積比大於25%定義為細胞外液容積比過剩;在男性則定義為大於28%。並不是每位血液透析的高血壓病人都有細胞外體液容積比過剩的問題。在心臟超音波檢查上,三十七位慢性高血壓血液透析病人中有九位(24%)其左心室在幾何學上為正常(normal geometry),六位(16%)為Concentric remodeling,四位(11%)為concentric hypertrophy,十八位(49%)為eccentric hypertrophy。所有細胞外體液容積過剩的病人其左心室都是eccentric hypertrophy。在多變相線形迴歸分析(multiple linear regression analysis)中,左心室質量指數(LVMI)只和細胞外液容積比呈正相關性(P<0.001)。細胞外體液容積比和舒張期左心室內徑寬呈正相關性,但和左心室後壁厚度及心室間隔厚度之間並無相關性。在逐漸降低細胞外液容積比過剩的六個病人的乾體重後,所有六個病人的細胞外體液容積比降至正常值,在統計學上的降低具有顯著的意義(27.39±2.12% vs 23.74±1.92%, p<0.005),而且左心室質量指數(155±19g/平方公尺) vs 115±34g/平方公尺, p<0.005)和舒張期左心室內徑寬(5.32±0.35 cm vs 4.45±0.37cm, P=0.019)的降低在統計學上也有顯著的意義;但左心室後壁厚度及心室間隔厚度則否。結論:在慢性高血壓血液透析病人可以細胞外體液容積和舒張期左心室內徑寬當作調節超過濾脫水的依據。 |
英文摘要 | Background: Volume overload is a major cause of hypertension and left ventricular hypertrophy (LVH) in hemodialysis patients. Ultrafiltration can achieve regression of LVH and reduce cardiac failure in hemodialysis patients. Adjusting ultrafiltration in hemodialysis is thus of great importance. Methods: We studied extracellular volume (ECV)% of 74 normal subjects and 37 chronic hypertensive hemodialysis patients. We analyzed the relationships between left ventricular mass index (LVMI), age, hematocrit, intact parathyroid hormone, duration of hemodialysis, height, weight, and ECV%. We also analyzed the relationships between ECV%, left ventricular internal diameter in diastole (LVMI), posterior wall thickness in diastole (PWTd) and interventricular septal thickness in diastole (IVSTd). In patients with excess ECY we decreased the dry weight by increased ultrafiltration and reassessed their ECV% and echocardiogram one year later. Results: ECV% exceeding 25% in female patients and 28% in males were defined as excess ECV% according to the 100th percentile of normal subjects. Not every hypertensive hemodialysis patient had excess ECV%. There were 9 (24%) normal geometry, 6 (16%) concentric remodeling, 4 (11%) concentric hypertrophy and 18 (49%) eccentric hypertrophy patients. All the patients with excess ECV had eccentric hypertrophy. On multiple linear regression analysis, LVMI correlated positively with ECV% (p<0.001) only. ECV% had positive correlation with LVMI, but no relation with PWTd and IVSTd. After reducing the dry weight of 6 patients with excess ECV%, all their ECV% decreased to normal range (27.39±2.12% vs. 23.74±1.92%, p<0.005). Both LVMI (155±19 g/m^2 vs. 115±34 g/m^2, p<0.005) and LVIDd (5.32±0.35 cm vs. 4.45±0.37 cm, p=0.019) also decreased significantly, but PWTd and WSTd did not. Conclusions: We could use ECV or LVIDd as guidance for ultrafiltration in hypertensive hemodialysis patients. |
本系統中英文摘要資訊取自各篇刊載內容。