Uremic Cardiomyopathy2017-06-23 10:39
Advanced chronic renal failure can occur myocardial disease, its pathogenesis remains unclear, may be related with the following factors:
(1) the role of metabolic toxins: it has been proved by experiments that the blood urea, creatinine, guanidine succinate and methyl guanidine, a single and combined with the inhibition of free rat heart. Uremia patients with abnormal ECG can be interpreted as the inhibition of myocardial cholinesterase activity, secondary hyperparathyroidism caused by increased parathyroid hormone in blood, can inhibit the contraction of cardiac muscle. In addition, secondary hyperparathyroidism, hypocalcemia, calcium deposition in the myocardium can cause myocardial calcification, the myocardial blood supply and oxygen supply decreased, calcium salt deposition in the conduction system may cause arrhythmia.
(2) increased cardiac load: long term hypertension, anemia and arteriovenous fistula blood flow is too large, both the heart load, myocardial damage. Glucose metabolism disorder and hyperlipidemia can accelerate atherosclerosis and decrease myocardial function.
(3): loss of malnutrition in uremic patients long-term loss of appetite, nausea and vomiting and long-term dialysis patients, hypoalbuminemia, creatine, easy to see a variety of trace elements and vitamin deficiency caused by malnutrition, malnutrition, cardiomyopathy, heart function is further reduced, viral or bacterial infection prone to malnutrition immune, low immunity, often caused by infection after myocardial lesions.
(4) effects of acetate dialysate: application of acetate dialysate hemodialysis, acetate can inhibit myocardial contractility, cardiac function failure.
(5): anemia anemia to cardiac output, reduce myocardial oxygen supply, resulting in myocardial dysfunction.
Treatment of uremic cardiomyopathy
Uremic cardiomyopathy is caused by many factors, so it is necessary to remove pathogenic factors. The effect of correcting anemia on improving myocardial function was extremely significant. Low dose subcutaneous injection of recombinant erythropoietin 25-50U/kg every time, 2-3 times a week, to correct anemia effect is good, often appear side effects such as high blood pressure, should pay attention to. The effect of frequent blood transfusion to correct anemia is poor, and the risk of hepatitis infection. Correction of electrolyte imbalance and acid-base imbalance, control of high blood pressure and infection, the addition of protein, essential amino acids and a variety of vitamins and trace elements, folic acid, help to improve myocardial function. Simply because of cardiomyopathy heart function is not complete, remove toxins with conventional hemodialysis therapy, the effect is often not satisfactory, if the application of high-performance dialyzer (increase the clearance, the molecular weight of toxicant and reduce load capacity), or hemofiltration or hemodiafiltration, can improve myocardial function.
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