摘要
目的探究维持性血液透析(MHD)患者甲状旁腺切除术(PTx)后血压昼夜节律的变化及其与心功能的关系。方法选择2016年10月至2020年12月于中国人民解放军总医院第六医学中心进行MHD并接受PTx治疗的200例继发性甲状旁腺功能亢进(SHPT)患者作为PTx组,另选取同期于本院进行MHD患者122例作为对照组。PTx组患者于手术前后检测甲状旁腺功能、超声心动图及24 h动态血压,对照组同期在血液透析前进行检测。依据术后血压昼夜节律情况将PTx组患者分为血压节律正常组和血压节律异常组,分析血压昼夜节律变化与心功能间的关系。结果PTx组术前全天收缩压及舒张压、夜间收缩压及舒张压均高于对照组,而夜间收缩压下降百分率(ΔSBP%)、舒张压下降百分率(ΔDBP%)均低于对照组;PTx组术后全天收缩压及舒张压、夜间收缩压及舒张压均较术前降低,夜间ΔSBP%、ΔDBP%均较术前升高[(10.6±2.2)%比(3.1±4.0)%、(10.8±2.6)%比(3.8±4.9)%],差异均有统计学意义(均P<0.05)。PTx组术前左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、左心室质量指数(LVMI)均高于对照组,左心室射血分数(LVEF)显著低于对照组,差异均有统计学意义(均P<0.05);PTx组术后LVESD、LVEDD、IVST、LVPWT、LVMI均较术前降低,LVEF较术前升高[(55±7)%比(47±9)%](均P<0.05)。依据患者PTx术后动态血压检测结果,分为血压节律正常组(132例)和血压节律异常组(68例)。血压节律异常组夜间收缩压、舒张压均高于血压节律正常组,夜间ΔSBP%、ΔDBP%均低于血压节律正常组,LVEDD、IVST、LVPWT及LVMI均高于血压节律正常组,LVEF低于血压节律正常组,差异均有统计学意义(均P<0.05)。逐步多重线性回归分析结果显示,MHD患者PTx术后LVMI与全天收缩压呈正相关,与夜间ΔSBP%呈负相关(均P<0.05)。结论PTx可有效控制MHD并发SHPT患者的甲�
Objective To explore the changes of circadian rhythm of blood pressure in maintenance hemodialysis(MHD)patients after parathyroidectomy(PTx)and its relationship with cardiac function.Methods From October 2016 to December 2020,200 MHD patients combined with secondary hyperparathyroidism(SHPT)undergoing PTx in the Sixth Medical Center of Chinese People’s Liberation Army General Hospital were selected as the PTx group,and 122 MHD patients in the hospital during the same period were selected as the control group.Patients in PTx group underwent parathyroid glands function,echocardiography and 24 h ambulatory blood pressure detection before and after operation,and the control group was detected during the same period before hemodialysis.According to circadian rhythm of blood pressure,patients in PTx group were divided into normal blood rhythm group and abnormal blood rhythm group.The relationship between circadian rhythm of blood pressure and cardiac function was analyzed.Results The all-day systolic blood pressure(SBP)and diastolic blood pressure(DBP),nocturnal SBP and DBP in PTx group before operation were higher than those in control group,while the percentage of nocturnal SBP decreasing(ΔSBP%)and the percentage of nocturnal DBP decreasing(ΔDBP%)in PTx group before operation were lower than those in control group;the all-day SBP and DBP,nocturnal SBP and DBP in PTx group decreased after operation,and nocturnalΔSBP%andΔDBP%increased after operation[(10.6±2.2)%vs(3.1±4.0)%,(10.8±2.6)%vs(3.8±4.9)%](all P<0.05).Left ventricular end systolic diameter(LVESD),left ventricular end diastolic diameter(LVEDD),interventricular septum thickness(IVST),left ventricular posterior wall thickness(LVPWT)and left ventricular mass index(LVMI)in PTx group before operation were higher than those in control group,and left ventricular ejection fraction(LVEF)in PTx group before operation was lower than that in control group(all P<0.05);in PTx group after operation,LVESD,LVEDD,IVST,LVPWT and LVMI decreased,and LVEF increased[(55±7)
作者
赵君
赵晖
于海
Zhao Jun;Zhao Hui;Yu Hai(Hemodialysis Unit,Department of Nephrology,the Sixth Medical Center of Chinese People's Liberation Army General Hospital,Beijing 100048,China)
出处
《中国医药》
2021年第11期1659-1663,共5页
China Medicine
关键词
维持性血液透析
甲状旁腺切除术
血压昼夜节律
心功能
Maintenance hemodialysis
Parathyroidectomy
Circadian rhythm of blood pressure
Cardiac function
