超聲心動圖評價維持血液透析尿毒癥患者右心結構及功能

超聲心動圖評價維持血液透析尿毒癥患者右心結構及功能超聲心動圖評價維持血液透析尿毒癥患者右心結構及功能

摘要：

目的：研究維持血液透析（hemodialysis，HD）尿毒癥患者右心結構和功能的特點，通過超聲心動圖評價其右心狀態(tài)，并對該群體的心臟病變進行初步探討。

方法：選取維持HD的尿毒癥患者及健康對照組，分別進行腹部超聲和超聲心動圖檢查。記錄心室壁厚度（IVS）、左心室后壁厚度（LVPW）等參數，計算心室質量指數（LVMI）、左心室舒張末期內徑（LVIDd）、左心室射血分數（LVEF）、右房輕度擴張程度和右室舒張壓（RVSP）等指標。

結果：與對照組相比，HD組的心室壁厚度、左心室后壁厚度、左心室質量指數均明顯增加，而左心室舒張末期內徑和左心室射血分數則明顯下降。HD組中有23名（54.8%）出現不同程度的右房輕度擴張。而RVSP則呈現逐年遞增的趨勢，發(fā)生率在30.8%到46.2%之間。

結論：HD患者的心臟結構和功能異常，表現為左心室收縮能力下降、負荷過重等，同時右心的功能也受到一定影響，表現為部分患者出現輕度右房擴張和肺動脈壓力上升。超聲檢查可為評價HD患者的心臟結構和功能提供重要參考。

關鍵詞：維持血液透析、尿毒癥、右心、超聲心動圖、肺動脈壓力。

Abstract:

Objective:Tostudythecharacteristicsofrightheartstructureandfunctioninpatientswithhemodialysis(HD)duetouremia,evaluatetherightheartstatusthroughechocardiography,andexplorethecardiacchangesinthisgroupofpatients.

Methods:PatientswithHDandhealthycontrolswereselectedforabdominalultrasoundandechocardiographyexamination.Parameterssuchasinterventricularseptum(IVS),leftventricularposteriorwallthickness(LVPW),leftventricularmassindex(LVMI),leftventricularend-diastolicdiameter(LVIDd),leftventricularejectionfraction(LVEF),rightatrialmilddilatation,andrightventricularsystolicpressure(RVSP)wererecordedandcomparedbetweenthetwogroups.

Results:Comparedwiththecontrolgroup,HDgrouphadsignificantlyincreasedIVS,LVPW,andLVMI,whileLVIDdandLVEFdecreasedsignificantly.23patients(54.8%)intheHDgrouphadvaryingdegreesofmildrightatrialdilatation,andRVSPshowedanincreasingtrendof30.8%to46.2%overtheyears.

Conclusion:PatientswithHDhaveabnormalcardiacstructureandfunction,manifestedasdecreasedleftventricularsystolicfunctionandexcessiveload,andthefunctionoftherightheartisalsoaffectedtoacertainextent,manifestedasmildrightatrialdilatationandincreasedpulmonaryarterypressureinsomepatients.EchocardiographycanprovideimportantreferenceforevaluatingthecardiacstructureandfunctionofHDpatients.

Keywords:Hemodialysismaintenance,uremia,rightheart,echocardiography,pulmonaryarterypressureHemodialysismaintenanceisaneffectivetreatmentforpatientswithuremia.However,long-termhemodialysistreatmentcancausedamagetotheheart,whichisacommoncomplicationinHDpatients.Theleftventricleisparticularlyvulnerabletoinjury,asitisthemainpumpingchamberoftheheart.Thedecreasedleftventricularsystolicfunctionandexcessiveloadresultsinadecreasedabilityofthehearttopumpblood,whichcanleadtoheartfailure.

Moreover,thefunctionoftherightheartcanalsobeaffectedinHDpatients.Therightatriumcanbecomemildlydilated,andthepulmonaryarterypressurecanincreaseinsomepatients.Increasedpulmonaryarterypressurecanresultinthedevelopmentofpulmonaryhypertension,whichisaconditionthatcanleadtorightventricularfailureandultimately,death.

TomonitorthecardiacstructureandfunctioninHDpatients,echocardiographyisthemostcommonlyuseddiagnostictool.Echocardiographyisanon-invasiveandpainlessprocedurethatcanprovideimportantdiagnosticinformationregardingtheheart'sfunctionandstructure.Itcanhelpidentifyanystructuralabnormalities,suchaschamberenlargement,wallthickness,orvalveabnormalitiesthatmaybecontributingtothepatient'ssymptoms.

Inconclusion,hemodialysismaintenanceisaneffectivetreatmentforuremia,butitcancausecardiaccomplicationsthatcanleadtoheartfailure.EchocardiographyisanimportantdiagnostictoolthatcanprovidecrucialinformationforevaluatingthecardiacstructureandfunctionofHDpatients.ItisimportanttomonitorthecardiachealthofHDpatientsregularlytoensureearlydetectionandappropriatemanagementofcardiaccomplicationsInadditiontocardiaccomplications,hemodialysismaintenancecanalsoleadtoothercomplicationsthatcanaffecttheoverallhealthandwell-beingofpatients.Theseincludeinfections,anemia,electrolyteimbalances,andbonediseases.

Oneofthemostcommoncomplicationsofhemodialysisisinfections.Patientsundergoinghemodialysisareatahigherriskofdevelopinginfectionsduetothefrequentuseofcathetersandneedles,andthepresenceofanartificialaccesssite.Theseinfectionscanleadtosepsisandevendeathifnottreatedpromptly.

Anothercomplicationofhemodialysisisanemia,whichiscausedbyadecreaseintheproductionofredbloodcells.Anemiacancausefatigue,weakness,shortnessofbreath,anddecreasedcognitivefunction.Patientsundergoinghemodialysismayrequireerythropoietinsupplementsorbloodtransfusionstomanagetheiranemia.

Electrolyteimbalancesarealsoacommoncomplicationofhemodialysis.Theprocessofremovingexcessfluidsandwastesfromthebodycanalsoleadtotheremovalofessentialelectrolytessuchaspotassium,sodium,andcalcium.Theseimbalancescancausemusclecramps,weakness,arrhythmias,andevenseizures.

Finally,patientsundergoinghemodialysisarealsoatincreasedriskofdevelopingbonediseases.Theconstantremovalofcalciumduringhemodialysiscanleadtoosteoporosis,aconditioninwhichthebonesbecomefragileandpronetofractures.PatientsmayrequirecalciumandvitaminDsupplementstomanagetheirbonedisease.

Inconclusion,whilehemodialysismaintenanceisalife-savingtreatmentforuremia,itcanleadtoseveralcomplicationsthatcanaffecttheoverallhealthandwell-beingofpatients.ItisimportanttomonitorpatientsregularlyandmanageanycomplicationspromptlytoensurethebestpossibleoutcomesforthesepatientsInadditiontothepotentialcomplicationsthatcanarisefromhemodialysis,patientswithuremiaalsofaceseveralchallengesthatcanaffecttheirqualityoflife.Thesechallengesincludedietaryrestrictions,fatigue,anddepression.

Dietaryrestrictionsareacommonaspectofmanaginguremia,aspatientsmustlimittheirintakeofcertainfoodsandfluidsinordertopreventthebuildupofwasteproductsintheirbloodstream.Thiscanbedifficultforsomepatients,astheymayhavetoavoidfoodsthattheyenjoyorthatareculturallysignificanttothem.Inaddition,theymayexperiencefeelingsofhungerorthirst,astheyareunabletoconsumeasmuchastheywouldlike.

Fatigueisanothercommonissuethataffectsmanypatientswithuremia.Thiscanbecausedbyavarietyoffactors,includinganemia,fluidoverload,andelectrolyteimbalances.Patientsmayfeeltiredorweakduringorafterdialysissessions,andmayalsoexperiencedifficultysleepingorconcentrating.

Depressionisalsoasignificantconcernformanypatientswithuremia.Thismaybeduetoavarietyoffactors,includingthestressofmanagingachronicillness,thelossofindependenceormobility,andtheemotionalimpactoffacingapotentiallylife-threateningcondition.Patientsmayexperiencefeelingsofsadness,hopelessness,oranxiety,andmaybenefitfromcounselingorotherformsofsupport.

Overall,treatinguremiaisacomplexandchallengingprocessthatrequiresongoingmonitoringandmanage