• Title/Summary/Keyword: 혈액투석 환자

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Impact of Hemodialysis on Left Ventricular Performance: A Doppler Echocardiographic Study (혈액투석 유지요법 환자에서 투석 전후의 좌심실 Doppler 심초음파를 이용한 기능지표의 변화)

  • Kang, Dong-Oh;Lee, Du-Ha;Kim, Hyun-Seo;Kim, Hyun-Su;Kim, Sung-Rok;Park, Jong-Seon
    • Journal of Yeungnam Medical Science
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    • v.16 no.2
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    • pp.309-317
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    • 1999
  • Background: Left ventricular diastolic filling is an important determinant for maintenance of cardiac output during hemodialysis. Few investigators have studied the influence of hemodialysis on diastolic function. To evaluate the change of left ventricular systolic and diastolic function. we performed M-mode and Doppler echocardiographic studies before and after hemodialysis. Methods: The study population consisted of 30 patients(15 patients were male, mean age $45{\pm}10$ years) with CRF on maintenance hemodialysis. They have normal left ventricular systolic function(Fractional shortening>30%) and no evidence of valvular heart disease or regional wall motion abnormalities. The ejection fraction (EF) was measured using M-mode echocardiography and Doppler indices such as peak E velocity, peak A velocity, isovolumetric relaxation time(IVRT), deceleration time(DT). and left ventricular ejection time(LVET) obtained from Doppler echocardiography. The index of myocardial performance (IMP) was calculated from each of the Doppler velocity indices. Results: The weight reduction after hemodialysis was $2.1{\pm}1.0kg$(p<0.0001), After hemodialysis, there was some decrease in blood pressure(p<0.05), but no significant change in heart rate, EF and fractional shortening, mean VCF, peak A velocity, and DT. And significant reduction in peak E velocity, E/A ratio(p<0.0001. p<0.001), and significant increase in IVRT and IMP(p<0.05, p<0.0001) were noted. Conclusion: In conclusion, preload reduction is the main mechanism that accounts for changes in Doppler diastolic indices after hemodialysis. And an increased IMP suggests that diastolic function may be aggravated after hemodialysis, and that implies impaired left ventricular filling and disturbed left ventricular compliance.

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The Characteristics of Blood Pressure Control in Chronic Renal Failure Patients Treated with Peritoneal Dialysis (복막 투석중인 만성 신부전 환자의 혈압 조절에 관한 연구)

  • Jung, Hang-Jae;Bae, Sung-Hwa;Park, Jun-Bum;Jo, Kyoo-Hyang;Kim, Young-Jin;Do, Jun-Young;Yoon, Kyung-Woo
    • Journal of Yeungnam Medical Science
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    • v.16 no.2
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    • pp.333-341
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    • 1999
  • Background and Methods: In order to evaluate characteristics and modulatory factors of blood pressure in peritoneal dialysis(PD), studies were conducted on the 69 patients who had underwent peritoneal equilibration test(PET). Results: The results were as follows; 1) All patients received an antihypertensive drug before PD, but, 15 of 69 patients successfully quit taking the antihypertensive drug after peritoneal dialysis. 2) During peritoneal dialysis, mean arterial pressure(MAP) was significantly decreased for the first 3 months, and this lasted for 1 year, and antihypertensive drug requirements were significantly decreased continuously up to 9 months(p<0.05). 3) After changing the modality from hemodialysis to peritoneal dialysis, MAP(mmHg, from $107.0{\pm}4.5$ to $98.6{\pm}8.8$, p<0.05), antihypertensive drug requirements(from $5.6{\pm}2.6$, to $2.0{\pm}2.5$, p<0.01) and erythropoietin dosages(Uint/week, from $4600{\pm}2660$ to $2000{\pm}1630$, p<0.05) were decreased. 4) Multiple logistic regression analysis showed that MAP(p<0.01) and daily ultrafiltration volume(p<0.05) can contribute to the determination of antihypertensive drug requirements. However the relationship between antihypertensive drug requirements and PET results or dialysis adequacy indices(weekly Kt/V, weekly creatinine clearance) was not revealed. Conclusion: In conclusion, the prescription of antihypertensive drugs should be considered according to daily ultrafiltration volume, especially during first year after initiating PD, and follow-ups for over a year may be needed.

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Factors Influencing on Early Patency Rate of Autogenous Arteriovenous Fistula for Hemodialysis (혈액투석을 위한 자가 동정맥루 수술에 있어서 조기개존율에 영향을 미치는 요인)

  • 민선경;한재진;원태희;안재호
    • Journal of Chest Surgery
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    • v.37 no.4
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    • pp.342-348
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    • 2004
  • It is very important for hemodialysis in patients with end stage renal disease to obtain vascular access that resists repeated punctures and maintains adequate blood flow. This study was designed to indentify factors that may influence early patency rate of autogenous arteriovenous fistula. Material and Method: 49 cases in 47 patients who underwent radiocephalic fistula formation in our hospital from June 2002 through May 2003 were reviewed and analyzed. Result: The early patency rate was 79.6%. Age, sex, hypertension, and diabetes mellitus were not significant factors for patency. Body mass index and duration of hypertension and diabetes did not influence the early results either. Cephalic vein diameter measured preoperatively and blood flow at radio-cephalic fistula were significantly positive correlative factors. Groups with the vein diameter less than 2.7mm, or with the blood flow less than 100 mL/min had significantly lower early patency rate than the other groups. Conclusion: To improve early patency rate of radiocephalic fistula, large sized cephalic vein should be selected and if the intraoperative flow at radiocephalic fistula is less than 100 mL/min, another arteriovenous fistula formation should be considered.

The Effectiveness of Stress Intervention Program for Hemodialysis Patients in Korea: A meta-analysis (국내 혈액투석환자의 스트레스 중재에 대한 효과 연구: 메타분석)

  • Bae, Yeon Hee;Lee, Ko Woon;Yeom, Hye Ah
    • Journal of the Korea Convergence Society
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    • v.11 no.2
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    • pp.361-373
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    • 2020
  • The purpose of this study was to meta-analyze the stress intervention program applied to patients with hemodialysis in Korea to confirm the effectiveness of the stress intervention program and to identify the characteristics and trends of the stress intervention method. A total of 10 studies were selected, and Quality Assessment tool was used MINORS and the data was analyzed using Comprehensive Meta Analysis Version 3.0 and Review manager version 5.3 The Quality Assessment score of studies was 21.2 points, and the effect size on the psychological stress was medium(g=-.72), and the effect size on cortisol of the physiological stress was also medium(g=-.52). Subgroup analysis showed that Music therapy and aromatherapy, individual providing, over 60 minutes per session and total of 10-20 times were more effectively reduced stress. Findings of this meta-analysis would be helpful for health professionals to provide more effective stress intervention program. Further randomized controlled trials of stress intervention program for patients with hemodialysis are more needed.

Active Infective Endocarditis with Vegetation of Right Atrium in Patient with End-stage Renal Disease (말기신부전환자에서 우심방 우종을 동반한 심내막염 환자의 수술 1례)

  • Kim, Chang-Young;Ahn, Hyuk
    • Journal of Chest Surgery
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    • v.35 no.9
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    • pp.680-683
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    • 2002
  • Infective endocarditis that involves the right side of the heart has been estimately 5% of all cases of infective endocarditis. It has been shown that about 70% of right-sided heart infective endocarditis cases have preexisting congenital heart disease or acquired valvular lesion. It would occur in intravenous drug users or end-stage renal disease patients with indwelling venous dialysis catheter. Antibiotic therapy is more effective in the right and, when it fails, the consequence of valve disruption and emboli are less. Patients receiving long-term hemodialysis are a unique population with regard in the risk of bacteremia and subsequent infective endocarditis. We experienced one case of the active infective endocarditis with right atrial vegetation without tricuspid or pulmonary valve involvement in patient with end-stage renal disease receiving long-term hemodialysis, who needed surgical correction after medical treatment failure. Then we reported it with references that right-sided heart infective endocarditis is rare, but difficult to diagnose, life-threatening because of delayed medical treatment.