ESRD肺动脉高压.ppt

ESRD肺动脉高压,肺动脉高压的定义,Systolicpulmonaryarterialpressure（PAP）PAP=cardiacoutputxPVR65重度SeminarsinDialysis,2006353-357,25mmHg,Mahansequation:rightventricularoutflowtractflowaccelerationtimeMPAP(mmHg)=79-0.45Xaccelerationtime(ms)Cardiacoutput(ml/min)=strokevolume(ml)Xheartrate(min-1)strokevolumefromend-diastolicvolumeSimpsonsmethod,modifiedBernoulliequation:,PAP=tricuspidsystolicjet(TR)+10-15mmHg(estimatedrightatrialpressure:15mmHgindilatedrightatrium10mmHginnormalorslightlyenlargedrightatriumPHT:systolicPAP35mmHg.,SystolicPAP=4xTR+RAP,TR:tricuspidregurgitation(m/sec)RAP:rightartialpressure60重度cardiovascInterventRadiol2005,28:17-22,40%血透患者：447mmHg(37-65),ESRDPH发生率与可能机制,1.leftheartfailure2.chronichypoxiclungdiseases.3.Collagenvasculardiseases,5.portalhypertension4.chronicrecurrentthromboembolism6.humanimmunodeficiencyvirus(HIV)infection,7.hematologicconditions8.Secondarydrugsandtoxins,我院血透中心不完全统计,HD27/59(45.8%)53.015.3mmHgPD15/51(29.4%)40.79.7mmHg,Table1.SystolicPulmonaryarterialpressure(PAP)inhemodialysispatients,SaudiJKidneyDisTranspl.2008Mar-Apr;19(2):189-93,PH相关因素,贫血、低蛋白血症PH者心输出量更高内皮功能（NOS-ET）AV内瘘患者、移植内瘘血流量与通路取栓术其它：年龄？转移性钙化,PH与低蛋白血症和贫血相关,controlPHHb11.11.869.81.97p=0.012Alb3.750.443.380.32p=0.02,SaudiJKidneyDisTranspl.2008Mar-Apr;19(2):189-93,SaudiJKidneyDisTranspl.2008Mar-Apr;19(2):189-93,PHA与心输出量和射血分数相关,CurrOpinNephrolHypertens15:353360.2006,PH与心输出量关系,平均PH与心脏射血分数相关r=0.453,p=0.014,IntUrolNephrol,2007,July,NO/内皮系统与肺动脉压关系,收缩血管物质ET-1所有透析患者，透后高于透前，高于正常对照HD/PH与HD/NPH没有差异透前后没有差异,CurrOpinNephrolHypertens15:353360.2006,扩血管物质NO2+NO3:所有透析患者透后升高HD/PHA透前后均低于非PHA患者,CurrOpinNephrolHypertens15:353360.2006,移植前后、A-V瘘闭前后PAP和心输出量的差别,ESRD取栓非CKDESRD未取栓Number88100117F/Males47:4154:4659:58age56.56054.7PH46(52%)26(26%)49(42%)Mild23(26%)1(1%)29(25%)Moderate9(10%)5(5%)1(1%)Severe14(16%)7(7%)5(4%)HD:PD88:0(100%)030:87(26%),通路取栓术与PH关系,CardiovascInterventRadiol(2005)28:1722,CardiovascInterventRadiol(2005)28:1722,PHA与透析一般情况无关,年龄、性别、透析时间血压吸烟心脏结构、瓣膜钙化、心输出量钙、磷、AKP、PTH血脂,CardiovascInterventRadiol(2005)28:1722,HemodialysisInternational2006;10:356359,Distributionofsystolicpulmonaryarterypressureaccordingtodegreeoftechnetium-99methylenediphosphonatepulmonaryuptake（99mTCMDP肺摄取肺钙