残余肾功能对老年血液透析患者心血管系统的影响.docVIP

【专家意见】 1、文章题为“残余肾功能对老年血液透析患者心血管系统的影响”，而入选的病人为“所有患者年龄≧60岁”，老年患者的年龄定义应该如何？ 既然为前瞻性临床研究，应该说明拟入组标准、入组人数、观察时间等，而不是如作者所说的“观察期限与透析时间相同”； 心超是患者于透析前一天检查的，那应该是与透析无关的；于透析前一天检查而透析期间发生的高血压、低血压、心力衰竭、心律失常和心绞痛等心血管并发症可能与残余肾功能及透析等因素有关，是否排除一些因素，如原有心血管并发症病史？是否导致肾功能衰竭的基础疾病可能会影响心血管并发症的出现呢？导致肾功能衰竭的基础疾病 残余肾功能对老年血液透析患者心血管系统的影响 武警新疆总队医院 【摘要 目的探讨残余肾功能对老年血液透析患者心血管系统的影响。方法选择2009年1月2011年6月我院肾病科进行血液透析治疗的老年患者157例，根据内生肌酐清除率（Ccr）将患者分为有RRF组和无RRF组，记录并对比两组患者的一般资料、实验室指标和超声检查结果，并对比两组透析期间心血管并发症发生率。结果157例患者中有RRF62例，无RRF95例，而有RRF组透析时间显著低于无RRF组，差异有统计学意义（P＜0.05）；有RRF组血肌酐(Scr)、血尿素氮（BUN）、收缩压（SBP）、舒张压（DBP）、血磷（P）和C-反应蛋白（CRP）均显著低于无RRF组，而血钙（Ca）、血红蛋白（Hb）和白蛋白（Alb）均显著高于无RRF组，差异均有统计学意义（P＜0.05）；有RRF组左心室后壁厚度（LVPWT）、左心室舒张期末内径（LVEDD）和室间隔厚度（IVST）均显著低于无RRF组，而左心室射血分数（LVEF）显著高于无RRF组，差异均有统计学意义（P＜0.05）；有RRF组透析期间心血管并发症发生率为16.13%，显著低于无RRF组的49.47%，差异有统计学意义（P＜0.05）。结论RRF可显著缩短透析时间，控制患者血压，改善炎症状态、营养状况和钙磷代谢，减轻左心室肥厚，降低心血管并发症发生率，值得进一步深入研究。 关键词 残余肾功能；血液透析；心血管系统；心脏超声 The influence of Residual renal function on the cardiovascular system in elderly hemodialysis patients [ABSTRACT] Objective: To explore the influence of Residual renal function on the cardiovascular system in elderly hemodialysis patients.Methods: Chose 157 cases elderly patients with kidney disease who treated with hemodialysis from January 2009 - June 2011 in our hospital,they were divided into RRF group and no RRF group according to the endogenous creatinine clearance rate (Ccr).Recorded and compared the general information, laboratory indexes and ultrasound examination results between two groups,and compared the cardiovascular complications between two groups during dialysis.Results: There were 62 cases patients in RRF group while other 95 cases patients in no RRF group, and the dialysis time in RRF group was significantly lower than that in no RRF group, the difference was statistically significant (P0.05); The levels of serum creatinine (Scr), blood urea nitrogen (BUN), systolic blood pressure (SBP), diastolic blood pressure (DBP), blood phosphorus (P) and C-reactive prot