维持性血液透析患者内瘘流量监测及危险因素分析

Factors associated with access blood flow in maintenance hemodialysis patients

目的监测维持性血液透析患者内瘘流量并探讨其危险因素。方法使用超声稀释法测定内瘘流量(access flow,Qa),再循环率及心输出量(cardiac output,CO),并结合多普勒超声及临床资料进行相关分析。结果共117例患者纳入本研究,平均Qa(896±454)ml/min,21例(17.9%)Qa<500ml/min,85例(72.6%)Qa为500～1500ml/min,11例(9.4%)Qa>1500ml/min。与非糖尿病组相比,糖尿病组患者Qa更低(t=4.615,P<0.001),内瘘狭窄的发生率更高(t=5.356,P=0.029)。Logistic回归显示糖尿病(OR=8.782,95%CI:1.862～41.412,P=0.006)和内瘘既往手术史(OR=4.087, 95%CI:1.082～15.437,P=0.038)是低Qa的独立危险因素。结论糖尿病是内瘘低流量最重要的独立危险因素,可能预示着内瘘预后不良。合并糖尿病的透析患者可能需要更为密切的监测内瘘功能,但尚需前瞻性研究进一步验证。

Objective The aim of this cross-sectional study was to investigate clinical factors associated with access blood flow in maintenance hemodialysis(MHD) patients. Methods Ultrasound dilution(UD)was used to measure access flow(Qa), recirculation rate and cardiac output(CO). Multivariate logistic regression was performed to evaluate the contribution of the variables on access flow. Results A total of 117 MHD patients were included in this study. Their mean Qa was 896±454 ml/min. UD measurements classified 21 cases(17.9%) having Qa <500 ml/min, 85 cases(72.6%) having Qa 500~1,500 ml/min, and 11 cases(9.4%)having Qa ≥1,500 ml/min. Patients with diabetes had significantly lower Qa(t=4.615, P<0.001) and higher prevalence of stenosis(t=5.356, P=0.029). Logistic regression analyses showed that diabetes history(OR 8.782, 95% CI: 1.862~41.412, P=0.006) and previous access surgery(OR 4.087, 95% CI: 1.082~15.437, P=0.04) were independently associated with lower access flow(Qa<500 ml/min). Conclusions History of diabetes is the most important independent risk factor for lower access flow in MHD patients and may indicate long-term poor access patency. Access flow surveillance may be helpful in these patients. A prospective cohort study is on our schedule to further validate the findings from this study.