肘部内瘘与腕部内瘘对维持性血液透析患者左心结构的影响

Effects of arteriovenous fistula at elbow and wrist on left ventricular structure in maintenance hemodialysis patients

目的比较肘部内瘘与腕部内瘘对维持性血液透析患者左心结构的影响。方法选择上海交通大学附属第一人民医院肾内科2007年10月至2011年1月维持性血液透析患者46例。分为肘部内瘘组(14例);腕部内瘘组(32例)。比较2组左心室射血分数(EF)、短轴缩短率(FS)、左心房内径(LAD)、主动脉根部内径(AAo)、左心室舒张末期内径(LVDd)、左心室收缩末期内径(LVDs)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、泵控血流量(Qb)、左室重量指数(LVMI)、相对壁厚度(RWT)及代表左心舒张功能的E/A。结果腕部内瘘组LAD较肘部内瘘组稍低[(40.59±4.72)mm比(42.07±9.17)mm,P<0.05];FS,AAo,LVDd,LVDs,IVST,LVPWT,LVM,LVMI及Qb在两组中无显著差异,2组患者的心脏功能也没有显著性差异(P>0.05)。结论与腕部内瘘相比,肘部内瘘并没有明显影响左心结构,并不成为高输出量性心力衰竭的高危因素。因此,在腕部内瘘不成功的情况下,可选择肘部内瘘作为长期透析的血管通路。

Objective To study the effects of arteriovenous fistula at elbow and at wrist on left ventricular structure in maintenance hemodialysis patients. Methods A total of 46 maintenance hemodialysis patients during October 2007 to January 2011 were enrolled in this study. Arteriovenous fistula was created at elbow in 14 cases （elbow group）, and at wrist in 32 cases （wrist group）. Left ventricular ejection fraction （EF）, shortening fraction （FS）, left atrium internal dimension （LAD）, aortic root internal dimension （AAo）, left ventricular end diastolic internal dimension （LVDd）, left ventricular end systolic internal dimension （LVDs）, interventricular septal thickness （IVST）, left ventricular posterior wall thickness （LVPWT）, pump controlled blood flow （Qb）,left ventricular mass index（LVMI）,relative wall thickness （RWI） and E/A were compared between the two groups. Results LAD was lower in wrist group than in elbow group （40.59±4.72 vs 42.07±9.17, P0.05）. There were no significant differences in FS, AAo, LVDd, LVDs, IVST, LVPWT, LVM, LVMI and Qb （P0.05） nor in left ventricular function between the two groups （P0.05）. Conclusion The effects of the two kinds of arteriovenous fistula on left cardiac structure are similar. Elbow arteriovenous fistula does not account for the high risk factor for high output cardiac failure among maintenance hemodialysis patients. Therefore, elbow arteriovenous fistula is a reasonable alternative vascular access when wrist arteriovenous fistula is difficult to be made in maintenance hemodialysis patients.