ESRD肺動脈高壓

1、esrd 肺動脈高壓肺動脈高壓的定義肺動脈高壓的定義 systolic pulmonary arterial pressure（pap） pap=cardiac output x pvr 65 重度 seminars in dialysis,2006 353-35725mmhg mahans equation: right ventricular outflow tract flow acceleration time mpap(mmhg)=79-0.45x acceleration time(ms) cardiac output(ml/min)=stroke volume(ml)xheart

2、 rate(min-1) stroke volume from end-diastolic volume simpsons methodmodified bernoulli equation: pap = tricuspid systolic jet (tr) + 10-15 mm hg (estimated right atrial pressure: 15 mm hg in dilated right atrium 10 mmhg in normal or slightly enlarged right atrium pht : systolic pap 35 mmhg.systolic

3、pap=4xtr+rap tr: tricuspid regurgitation(m/sec) rap: right artial pressure60 重度 cardiovasc intervent radiol 2005,28:17-22 40%血透患者：447mmhg(37-65)esrd ph發(fā)生率與可能機(jī)制1.left heart failure 2. chronic hypoxic lung diseases. 3. collagen vascular diseases, 5.portal hypertension4. chronic recurrent thromboemboli

4、sm6.human immunodeficiency virus (hiv) infection, 7.hematologic conditions 8.secondary drugs and toxins我院血透中心不完全統(tǒng)計hd 27/59(45.8%) 53.015.3mmhgpd 15/51(29.4%) 40.79.7mmhgtable 1. systolic pulmonary arterial pressure (pap) in hemodialysis patients saudi j kidney dis transpl. 2008 mar-apr;19(2):189-93

5、ph相關(guān)因素 貧血、低蛋白血癥貧血、低蛋白血癥 ph者心輸出量更高者心輸出量更高 內(nèi)皮功能（內(nèi)皮功能（nos-et） av內(nèi)瘺患者、移植內(nèi)瘺患者、移植 內(nèi)瘺血流量與通路取栓術(shù)內(nèi)瘺血流量與通路取栓術(shù) 其它：年齡？其它：年齡？轉(zhuǎn)移性鈣化轉(zhuǎn)移性鈣化ph與低蛋白血癥和貧血相關(guān)與低蛋白血癥和貧血相關(guān) control ph hb 11.1 1.86 9.8 1.97 p=0.012 alb 3.75 0.44 3.38 0.32 p=0.02saudi j kidney dis transpl. 2008 mar-apr;19(2):189-93 saudi j kidney dis transpl. 2

6、008 mar-apr;19(2):189-93 pha與心輸出量和射血分?jǐn)?shù)相關(guān)curr opin nephrol hypertens 15:353360. 2006ph與心輸出量關(guān)系 平均ph 與心臟射血分?jǐn)?shù)相關(guān) r=0.453,p=0.014int urol nephrol, 2007,julyno/內(nèi)皮系統(tǒng)與肺動脈壓關(guān)系收縮血管物質(zhì)收縮血管物質(zhì)et-1所有透析患者，透后所有透析患者，透后高于透前，高于正常高于透前，高于正常對照對照hd/ph與與hd/nph沒沒有差異有差異透前后沒有差異透前后沒有差異curr opin nephrol hypertens 15:353360. 2006擴(kuò)血

7、管物質(zhì)擴(kuò)血管物質(zhì)no2+no3:所有透析患者透后所有透析患者透后升高升高h(yuǎn)d/pha透前后均低透前后均低于非于非pha患者患者curr opin nephrol hypertens 15:353360. 2006移植前后、a-v瘺閉前后pap和心輸出量的差別 esrd取栓取栓 非非ckd esrd未取栓未取栓number 88 100 117f/males 47:41 54:46 59:58age 56.5 60 54.7ph 46 (52%) 26 (26%) 49 (42%) mild 23 (26%) 1(1 %) 29 (25%)moderate 9 (10%) 5(5%) 1(1 %

8、) severe 14 (16%) 7(7%) 5(4%)hd:pd 88:0 (100%) 0 30:87 (26%)通路取栓術(shù)與ph關(guān)系cardiovasc intervent radiol (2005) 28:1722cardiovasc intervent radiol (2005) 28:1722pha與透析一般情況無關(guān) 年齡、性別、透析時間年齡、性別、透析時間 血壓血壓 吸煙吸煙 心臟結(jié)構(gòu)、瓣膜鈣化、心輸出量心臟結(jié)構(gòu)、瓣膜鈣化、心輸出量 鈣、磷、鈣、磷、akp、pth 血脂血脂cardiovasc intervent radiol (2005) 28:1722hemodialysis international 2006; 10:356359distribution of systolic pulmonary artery pressureaccording to degree of technetium-99 methylene diphosphonatepulmonary uptake（99mtcmdp