DIJASTOLNA SRČANA SLABOST KOD BOLESNIKA NA HEMODIJALIZI: ETIOPATOGENEZA, DIJAGNOSTIKA I LEČENJE

  • Branislava D Nedeljković Klinički centar Kragujevac, Klinika za nefrologiju i urologiju

Sažetak


Uvod. Bolesti srca su vodeći uzrok smrti bolesnika koji se leče hemodijalizom. Stopa kardiovaskularnog mortaliteta kod ovih bolesnika iznosi približno 9% godišnje, a među kardiovaskularnim komplikacijama najveća je prevalenca hipertrofije leve komore, ishemijske bolesti srca i zastojne srčane slabosti. Cilj. Rad je imao za cilj da utvrdi faktore kardiovaskularnog rizika, patogenetske mehanizme razvoja poremećaja dijastolne funkcije srca, i da ukaže na klinički značaj ranog otkrivanja i pravovremenog lečenja bolesnika sa poremećajem dijastolne funkcije srca. Metod. Analizirani su stručni radovi i kliničke studije koje se bave dijagnostikovanjem i lečenjem poremećaja dijastolne funkcije srca u populaciji bolesnika koji se leče hemodijalizom. Rezultati. Hipertrofiju leve komore ima 75% bolesnika koji se leče hemodijalizom. U faktore rizika za razvoj hipertrofije leve komore kod bolesnika na hemodijalizi spadaju: povećan  protok krvi kroz arterio-vensku fistulu, anemija, povećana zapremina vanćelijske tečnosti, hipertenzija, oksidativni stres, mikroinflamacija, hiperhomocisteinemija i sekundarni hiperparatireoidizam. Hipertrofija leve komore je značajan uzrok poremećaja dijastolne funkcije leve komore u ovoj populaciji bolesnika. Dijagnostička strategija za rano otkrivanje bolesnika sa povećanim rizikom za razvoj asimptomatskog poremećaja dijastolne funkcije leve komore treba da uključi: ehokardiografski pregled, testove za dokazivanje koronarne arterijske bolesti, kao i testove za procenu funkcije miokarda. Zaključak. Rano otkrivanje bolesnika sa visokim rizikom za razvoj dijastolne srčane slabosti omogućava pravovremenu primenu odgovarajuće strategije lečenja, koja obezbeđuje visok stepen preživljavanja bolesnika na hemodijalizi.

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2014/06/28
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