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1、ESRD 肺动脉高压,肺动脉高压的定义,Systolic pulmonary arterial pressure（PAP）PAP=cardiac output x PVR65 重度 Seminars in Dialysis,2006 353-357,25mmHg,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 rate(min-
2、1)stroke volume from end-diastolic volume Simpsons method,modified 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 atriumPHT:systolic PAP 35 mmHg.,Systolic PAP=4xTR+RAP,TR:tri
3、cuspid 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 thromboembolism6.human immunodeficienc
4、y 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%)40.79.7mmHg,Table 1.Systolic Pulmonary arterial pressure(PAP)in hemodialysis patients,Saudi J Kidney Dis Transpl.2008 Mar-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（NO
5、S-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,control PHHb 11.1 1.86 9.8 1.97 p=0.012 Alb 3.75 0.44 3.38 0.32 p=0.02,Saudi J Kidney Dis Transpl.2008 Mar-Apr;19(2):189-93,Saudi J Kidney Dis Transpl.2008 Mar-Apr;19(2):189-93,PHA与心输出量和射血分数相关,Curr Opin Nephrol Hypertens 15:353360.2006,PH与心输出量关系,平均P
6、H 与心脏射血分数相关 r=0.453,p=0.014,Int Urol Nephrol,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,Curr Opin Nephrol Hypertens 15:353360.2006,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,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 非CKD ESRD未取栓Numbe
7、r 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%)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)28:1722,Cardiovasc Intervent Radiol(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
8、脏结构、瓣膜钙化、心输出量钙、磷、AKP、PTH血脂,Cardiovasc Intervent Radiol(2005)28:1722,Hemodialysis International 2006;10:356359,Distribution of systolic pulmonary artery pressureaccording to degree of technetium-99 methylene diphosphonatepulmonary uptake（99mTCMDP肺摄取肺钙化）,Curr Opin Nephrol Hypertens 15:353360.2006,CASE REVIEW,1.新发肺动脉高压 1年2.高血压、贫血、AV瘘3.射血分数、容量负荷：变化？4.肺基础：血管张力？低氧？肺栓塞？AV分流,
