ESRD肺动脉高压

1、esrd 肺动脉高压肺动脉高压的定义肺动脉高压的定义 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发生率与可能机制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统计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相关因素 贫血、低蛋白血症贫血、低蛋白血症 ph者心输出量更高者心输出量更高 内皮功能（内皮功能（nos-et） av内瘘患者、移植内瘘患者、移植 内瘘血流量与通路取栓术内瘘血流量与通路取栓术 其它：年龄？其它：年龄？转移性钙化转移性钙化ph与低蛋白血症和贫血相关与低蛋白血症和贫血相关 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与心输出量和射血分数相关curr opin nephrol hypertens 15:353360. 2006ph与心输出量关系 平均ph 与心脏射血分数相关 r=0.453,p=0.014int urol nephrol, 2007,julyno/内皮系统与肺动脉压关系收缩血管物质收缩血管物质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，高于正常对照对照hd/ph与与hd/nph没没有差异有差异透前后没有差异透前后没有差异curr opin nephrol hypertens 15:353360. 2006扩血

7、管物质扩血管物质no2+no3:所有透析患者透后所有透析患者透后升高升高hd/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瘘闭前后pap和心输出量的差别 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%)通路取栓术与ph关系cardiovasc intervent radiol (2005) 28:1722cardiovasc intervent radiol (2005) 28:1722pha与透析一般情况无关 年龄、性别、透析时间年龄、性别、透析时间 血压血压 吸烟吸烟 心脏结构、瓣膜钙化、心输出量心脏结构、瓣膜钙化、心输出量 钙、磷、钙、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