目的 評(píng)價(jià)左卡尼汀對(duì)尿毒癥維持血液透析患者營(yíng)養(yǎng)不良及心功能的改善作用。方法 將2012年12月-2013年12月中國(guó)人民解放軍海軍總醫(yī)院收治的尿毒癥患者74例隨機(jī)分成治療組（37例）和對(duì)照組（37例）。對(duì)照組采用常規(guī)血液透析治療，治療組在常規(guī)血液透析的基礎(chǔ)上，于每次透析結(jié)束后iv左卡尼汀注射液1 g，連續(xù)治療3個(gè)月。觀察治療前后兩組患者的血清總蛋白（TP）、白蛋白（Alb）、轉(zhuǎn)鐵蛋白（TRF）、前白蛋白（PA）和以及心功能情況。結(jié)果 治療組患者治療后血清營(yíng)養(yǎng)學(xué)指標(biāo)TP、Alb、TRF、PA均較治療前有所升高，治療前后比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；治療組總膽固醇（TC）水平較治療前顯著下降，治療前后比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05），且顯著低于對(duì)照組治療后水平（P<0.05）；治療后，治療組TP、Alb、TRF、PA水平均顯著高于對(duì)照組，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后兩組患者的左心房?jī)?nèi)徑（LAD）、左室后壁厚度（LVPWT）、室間隔厚度（IVST）較治療前均有顯著性減小，同組治療前后差異有統(tǒng)計(jì)學(xué)意義（P<0.05），且治療組左室收縮末內(nèi)徑（LVDs）、左室舒張末內(nèi)徑（LVDd）較治療前變化顯著，治療前后差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，治療組LAD、LVDs、LVDd和LVPWT值均低于對(duì)照組，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后兩組患者的舒張期始末血流速度E、A峰比值（E/A）、左室射血分?jǐn)?shù)（EF）均較治療前顯著增加，治療前后差異有統(tǒng)計(jì)學(xué)意義（P<0.05），治療組計(jì)算左房每搏量（SV）較治療前顯著性減小，治療前后差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，治療組E/A、EF均顯著高于對(duì)照組，治療組SV顯著性低于對(duì)照組，兩組差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 iv左卡尼汀可明顯改善尿毒癥血液透析患者營(yíng)養(yǎng)不良的狀況，保護(hù)心肌細(xì)胞，延緩心臟結(jié)構(gòu)及功能的進(jìn)一步損害，值得臨床推廣應(yīng)用。

Objective To evaluate the effect of L-carnitine on improving the malnutrition and cardiac function in uremia with hematodialysis. Methods Seventy four cases in Navy General Hospital of PLA from December 2012 to December 2013 were randomly divided into treatment (37 cases) and control (37 cases) groups. The patients in each group were given a conventional hematodialysis therapy, while the patients in the treatment group were iv given 1g L-carnitine injection after the end of each dialysis for 3 months. The levels of total protein (TP), albumin (Alb), transferrin (TRF), and prealbumin (PA) as well as the cardiac function were observed before and after the treatment. Results After the treatment, the levels of TP, Alb, TRF, and PA were increased and there was a significant difference among them before and after the treatment (P<0.05). The total cholesterol was significantly lower in the treatment group than that before treatment and there was a significant difference before and after the treatment (P<0.05), which was significantly lower than that after the treatment in the control group (P<0.05). After the treatment, the TP, Alb, TRF, and PA in the treatment group were significantly higher than those in the control group (P<0.05). After the treatment, the left ventricular diameter (LAD), left ventricular posterior wall thickness (LVPWT), and the inter-ventricular septum thickness (IVST) were significantly reduced in the two groups than those before the treatment (P<0.05). There was a significant difference before and after the treatment in the same group (P<0.05), and comparing to that before the treatment, the left ventricular end systolic diameter (LVDs) and left ventricular end diastolic diameter (LVDd) in the treatment group were obviously improved with a significant difference (P<0.05). After the treatment, the levels of LAD, LVDs, LVDd, and LVPWT in the treatment group were lower than those in the control group with a significant difference (P<0.05). After the treatment, the E/A value and the left ventricular ejection fraction (EF) were more significantly increased than those before the treatment in the two groups (P<0.05), and the calculated left atrial stroke volume (SV) after the treatment was obviously decreased than that before the treatment in the treatment group with a significant difference (P<0.05). After the treatment, the E/A and EF values in the treatment group were significantly higher than those in the control group, while the SV value was significantly lower than that in the control group. There was a significant difference between the two groups (P<0.05). Conclusion Iv injection of L-carnitine could significantly improve the situation of malnutrition in hemodialysis patients, protect the myocardial cells and delay the further damage of the cardiac structure and function, which is worthy of clinical application.