本文選題：維持性血液透析 + 脈壓指數(shù)　； 參考：《青海大學(xué)》2016年碩士論文

【摘要】：目的:探討維持性血液透析(MHD)患者脈壓指數(shù)(PPI)與左心結(jié)構(gòu)及功能的相關(guān)性并進一步分析左心結(jié)構(gòu)及功能的影響因素。方法:隨機收取于2007年1月-2016年2月在青海大學(xué)附屬醫(yī)院的腎病內(nèi)科血液透析中心規(guī)律行低通量血液透析治療的相對完整的患者病歷資料共76份,記錄患者的人口學(xué)資料、生化指標(biāo)、透析齡(DA)及左心結(jié)構(gòu)及功能指標(biāo),記錄1個月內(nèi)所有患者的透析前SBP、DBP、超濾量(UF)、透析間期體重增長百分比(IDWG),計算脈壓(PP)、平均動脈壓(MAP)、脈壓指數(shù)(PPI)。采用SPSS 17.0進行統(tǒng)計學(xué)分析,探討脈壓指數(shù)與左心結(jié)構(gòu)及功能的相關(guān)性并進一步分析左心結(jié)構(gòu)及功能改變的影響因素,檢驗水準(zhǔn)為α=0.05。結(jié)果:1.LVH組的SBP、PP、PPI、IDWG較非LVH組高,而HGB、TG較非LVH組低,差異有統(tǒng)計學(xué)意義(P0.05)。兩組間的Age、DA、UF、TP、ALB、GLB、AST、LDH、HBDH、CK、CKMB、MYO、BUN、UA、TCH、LDL、HDL、Ca、P、i PTH、DBP、MAP差異無顯著性(P0.05)。2.PP與LA、IVS、LVMI呈顯著正相關(guān),差異有統(tǒng)計學(xué)意義(P0.05),相關(guān)系數(shù)從大到小依次為LVMI(0.441)、LA(0.342)、IVS(0.260)。而與LVd、LVPW及左心功能無相關(guān)性,差異無統(tǒng)計學(xué)意義(P0.05);PPI與LVMI、LA正相關(guān),差異有統(tǒng)計學(xué)意義(P0.05),相關(guān)系數(shù)從大到小分別為LVMI(0.339)、LA(0.276)。與LVd、LVPW、IVS及左心功能無相關(guān)性,差異無統(tǒng)計學(xué)意義(P0.05)。3.SBP是LVd、IVS、LVPW、LVMI、EDV、SV、CO等左心結(jié)構(gòu)及功能改變的最重要影響因素;HGB是LVMI及CI的重要影響因素;IDWG是LVPW的重要影響因素;PP是LA改變的重要影響因素;PPI雖與LA及LVMI存在正相關(guān),但PPI可能不是導(dǎo)致左心結(jié)構(gòu)及功能改變的影響因素,其與MHD患者心血管事件的相關(guān)性主要基于SBP、HGB的變化。結(jié)論:1.維持性血液透析患者左室肥厚常見,且左室肥厚者脈壓指數(shù)高于非左室肥厚者。2.脈壓指數(shù)與LA、LVMI正相關(guān),可能不是導(dǎo)致左心結(jié)構(gòu)及功能改變的主要影響因素,收縮壓是左心結(jié)構(gòu)及功能改變最重要的影響因素。3.控制血壓尤其是SBP、減少脈壓差、控制透析間期體重增長、改善貧血可能改善MHD患者左心重構(gòu)及心功能。
[Abstract]:Objective: to investigate the correlation between pulse pressure index (PPI) and left ventricular structure and function in patients with maintenance hemodialysis (MHD) and to analyze the influencing factors of left ventricular structure and function. Methods: a total of 76 patient records were collected randomly from January 2007 to February 2016 in the Nephrology Hemodialysis Center of Qinghai University affiliated Hospital for low-flux hemodialysis. The demographic data of the patients were recorded. Biochemical parameters, age of dialysis (DAA) and left ventricular structure and function were recorded in all patients before dialysis. SBP, UF, IDWGG, average arterial pressure (map), pulse pressure index (PPI) and pulse pressure index (PPI) were recorded in all patients within one month. SPSS 17.0 was used to analyze the correlation between pulse pressure index and left ventricular structure and function, and the influencing factors of left ventricular structure and function were further analyzed. The test level was 偽 0.05. Results 1. In LVH group, the level of LVH / PPIP LVH IDWG was higher than that of non-LVH group, while the level of TG was lower than that of non-LVH group, the difference was statistically significant (P 0.05). There was no significant positive correlation between the two groups (P 0.05.2.PP and LAIVSL LVMI, P 0.05.2.The difference was statistically significant, and the correlation coefficient from large to small was 0.441L 0.342VS0.260.) there was no significant positive correlation between the two groups (P 0.05.2.The difference was statistically significant) between the two groups, and the correlation coefficient from big to small was: MI0.441L0.342IVS0.2600.The difference between the two groups was not significant (P0.05.2.The difference between PP and LAIVSLVMI was statistically significant, and the correlation coefficient from big to small was as follows: MI0.441L0.342VS0.260nil.) the difference between the two groups was not significant (P 0.05.2.PP and LAIVSL LVMI) were significantly higher than those in the control group. There was no significant correlation between LVPW and LVPW and left ventricular function, but there was no significant difference between P0.05PPI and LVMILA. There was no correlation between LVD and LVPWV IVS and left ventricular function. There was no significant difference between them (P 0.05). 3. SBP was the most important factor influencing the structure and function of left heart, such as LVDIVS, LVMI, EDV, LVMI, etc. HGBwas an important factor of LVMI and CI. LVPW was an important influencing factor. PP was an important influencing factor of LA, although there was a positive correlation between PPI and LA and LVMI. However, PPI may not be the influencing factor for the changes of left ventricular structure and function, and its correlation with cardiovascular events in patients with MHD is mainly based on the changes of SBP / HGB. Conclusion 1. Left ventricular hypertrophy is common in maintenance hemodialysis patients, and the pulse pressure index in patients with left ventricular hypertrophy is higher than that in non-left ventricular hypertrophy patients. Pulse pressure index was positively correlated with LVMI, which may not be the main influencing factor for the change of left ventricular structure and function, and systolic pressure was the most important factor for the change of left ventricular structure and function. Control of blood pressure, especially SBP, reduction of pulse pressure difference, control of weight gain during dialysis period, improvement of anemia may improve left ventricular remodeling and cardiac function in patients with MHD.
【學(xué)位授予單位】：青海大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R459.5

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