| Objective: cardiovascular disease is a common complication and cause of death in maintenance dialysis patients.Among them,left ventricular hypertrophy and systolic and diastolic dysfunction are the most common cardiovascular complications in dialysis patients.The purpose of this study was to analyze the dynamic changes of the left ventricular structure,systolic and diastolic function of ESRD patients by combined dialysis.Methods: the combined dialysis patients were selected from January 2009 to December 2017 in the peritoneal dialysis center of our hospital.All patients undergoing cardiac catheterization during peritoneal dialysis and dialysis after ultrasound examination,echocardiography review.Record heart super index included ventricular septal thickness(interventricularseptal,thickness,IVST),left ventricular wall thickness(left ventricular posterior wall thickness,LVPWT),left ventricular end diastolic diameter(left ventricular end diastolic diameter,LVEDD),left ventricular systolic diameter(left ventricular end shrink at diameter,LVESD),left ventricular(left ventricular ejection fraction systolic fraction,left atrial diameter(LVEF),left atrial diameter,LAD),distance(valve opening valve distance,VOD(internal),diameter of aorta,aorta,pulmonary artery pressure(IDA),pulmonary arterial pressure,PAP),early diastolic mitral flow velocity maximum ventricular filling E peak late diastolic mitral flow and ventricular filling peak maximum speed of A.The left ventricular myocardial weight(left ventricular mass index,LVM)and weight index(LVMI)were calculated according to the formula.The correlation formula was LVM=1.04*[(LVDd+IVST+LVPWd)3-LVDd3]-13.6 and LVMI=LVM/BSA(body surface area).Assessment of left ventricular hypertrophy(Left ventricular hypertrophy,LVH LVMI)is defined as the male more than 134g/m2,the female is more than 110 g/m2 for the diagnosis of left ventricular hypertrophy(LVH): EF is less than 50% for the diagnosis of left ventricular systolic dysfunction;E/A is less than 1 for the diagnosis of left ventricular diastolic function.The patient's body surface area(body surface area,BSA)and the left atrium diameter index(left atrial diameter index,LADI,LAD/BSA)were calculated.Patients were collected during intubation of the age,gender,blood routine and biochemical indexes of the corresponding line super day heart ultrasound,including hemoglobin(Hb),albumin(ALB),prealbumin(PA),serum creatinine(Scr),blood urea nitrogen(BUN),serum calcium,phosphorus,parathyroid hormone(PTH)(SBP),systolic blood pressure,diastolic blood pressure(DBP),24 hour urine volume,HD ultrafiltration,ultrafiltration,PD before and after appearing through D/P 4h Cr,D/P weight,4h GLu.At the same time,the use of antihypertensive drugs,ESA and other drugs was recorded.A single factor repeated measurement of variance analysis(ANOVA)was used to analyze the changes of left ventricular structure and function in peritoneal dialysis patients.All data were statistically analyzed using SPSS22.0,and P value<0.05 was statistically significant.Results: a total of 34 patients were included in the study,of which 26 were male and 8 were female.After 66 months' follow-up during the period of dialysis,2 cases of cardiac overload were compared before and after combined dialysis.The results showed that1.men and women,with an average time of 66±32 months of peritoneal dialysis,12.2±2.4 months of combined dialysis.2.The causes of PHD were: 9 cases of ultrafiltration failure,6 cases with insufficient dialysis,11 cases of volume overload,and 8 other cases.3.The average value of SBP in peritoneal dialysis patients was 141.7±21.8mm Hg,and the average SBP value of patients in combined dialysis group was 135.5±15.6mm Hg.The average DBP value of peritoneal dialysis patients was 85.7 ±1.9mm Hg,and the average DBP value of combined dialysis patients was 82.7±8.3mm Hg.The average value of HGB in peritoneal dialysis patients was 96±18.4g/L,and the average value of HGB in combined dialysis patients was 101.3±14.0g/L.The average value of ALB in peritoneal dialysis patients was 35.1±5.2g/L,and the average value of ALB in combined dialysis patients was 36.4±4.8g/L.The average dose of ESA in peritoneal dialysis patients was 4.29±0.4*104 units per week,and the average dose of ESA in combined dialysis patients was 3.5±0.3*104 per week.The average value of Scr in peritoneal dialysis patients was 1209.6±259.4mmol/L,and the average value of Scr in combined dialysis patients was 1127.8±227.3mmol/L.The average value of BUN in peritoneal dialysis patients was 19.2 ±5.5mmol/L,and the average value of BUN in combined dialysis patients was 18.2± 4.8mmol/L.The average value of BUN in peritoneal dialysis patients was 19.2 ±5.5mmol/L,and the average value of BUN in combined dialysis patients was 18.2 ±4.8mmol/L.The average blood calcium in peritoneal dialysis patients was 2.32± 0.16mmol/L,and the average blood calcium in the combined dialysis patients was 2.24± 0.16mmol/L.The average blood phosphorus of the patients with peritoneal dialysis was 1.96±0.54mmol/L,and the average blood phosphorus of the combined dialysis patients was 1.84±0.49mmol/L.The average value of parathyroid hormone in peritoneal dialysis patients was 285.6±201.7pg/m L,and the average value of parathyroid hormone in combined dialysis patients was 234.2±127.5 pg/m L.The average urine volume of the patients with peritoneal dialysis was 75±171 m L,and the average urine volume in the combined dialysis patients was 90±189 m L.The average value of ultrafiltration in peritoneal dialysis patients was 1092±591 m L,and the average value of ultrafiltration in combined dialysis patients was 1133±531 m L.The average total fluid output of peritoneal dialysis patients was 1167±581 m L,and the average total fluid output of the combined dialysis patients was 1223±525 m L.4.The average value of EF in peritoneal dialysis patients was 62.27 ±7.35,and the average value of EF in combined dialysis patients was 64.26±9.50.5.Peritoneal dialysis patients the incidence of LVH was 66.7%,the incidence rate of LVH combined with dialysis patients 61.8%,peritoneal dialysis patients with the average value of LVMI is 173.8±86.1g/m2,combined with dialysis patients with the average value of LVMI is 160.5±78.5g/m2,peritoneal dialysis patients the valve open average distance is 20.93±2.41 mm,combined the valve open distance average dialysis patients a value of 20.11±2.23 mm.Conclusion:1.Combined dialysis reduced the level of blood pressure in the patients.2.Combined dialysis improved the patient's capacity and increased the amount of ultrafiltration and liquid total.3.After combined dialysis,the nutritional status of the patients was improved.Hemoglobin,albumin and prealbumin were all rising,and the use of Es A was less than that of PD before.4.Combined dialysis improved the patient's mineral metabolism disorder,and the blood calcium,blood phosphorus and parathyroid hormone showed a downward trend.5.Combined dialysis improved the patient's dialysis adequacy,and the blood creatinine and urea nitrogen showed a downward trend.6.Combined dialysis improved the left ventricular hypertrophy and systolic and diastolic function of the heart. |
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