维持性血液透析患者自体动静脉内瘘血流量与心输出量和平均动脉压变化的相关性探讨

The correlation between arteriovenous fistula access flow and the changes of cardiac output and mean arterial pressure in maintenance hemodialysis patients

目的观察使用自体动静脉内瘘(arteriovenous fistula,AVF)进行维持性血液透析(maintenance hemodialysis,MHD)患者的内瘘血流量(Qa)、心输出量(CO)和平均动脉压(MAP)的变化。方法选取使用自体动静脉内瘘进行MHD的患者54例。采用超声稀释法观察血液透析开始后30min、120min和180min3个时间点Qa、CO和MAP的变化,观察Qa的变化趋势及CO和MAP在不同时间点对Qa的影响。结果一次血液透析过程中3个时间点检测的患者动静脉内瘘血流量,以及各时间点心输出量、平均动脉压无明显波动,变化均无显著性差异(P>0.05)。透析过程中患者的动静脉内瘘Qa与即刻CO及MAP均成正相关(P<0.05)。透析30min至透析180min之间Qa变化的百分比(△Qa1-3%)与CO变化的百分比(△CO1-3%)(r=0367,P=0.009),与MAP变化的百分比(△MAP1-3%)(r=0.455,P=0.001)均存在正相关性。超滤量大于干体质量5%的患者Qa的变化及CO的变化显著大于超滤量小于干体质量5%的患者。(P<0.05)。结论MHD患者在血液透析过程各个时间段的动静脉内瘘血流量、心输出量、平均动脉压基本稳定并呈正相关,随着超滤脱水量的增加会影响内瘘血流量及心输出量的明显变化,进而影响血流动力学的稳定性。

Objective To observe the relationship between blood access from arteriovenous fistula（Qa）and the changes of cardiac output（CO） and mean arterial pressure（MAP） in maintenance hemodialysis（MHD） patients.Method A total of 54 MHD patients with arteriovenous fistula（AVF） were enrolled in this study.Variations of Qa by ultrasound dilution technique,CO,and MAP were observed at 30 minutes,2 hours,and 3 hours after starting a hemodialysis session to study Qa affected by the changes of CO and MAP in a hemodialysis session.Result Qa,CO and MAP changed insignificantly at the 3 time points in a hemodialysis session（P〉0.05）.Qa was positively correlated with CO and MAP at the same time point（P〈0.05）.,The percentage of Qa variation within the 3 time points（△Qa1-3%） was positively correlated with the percentage of CO variation（△CO1-3%）（r=0367,P=0.009）,and the percentage of MAP variation（△MAP1-3%）（r=0.455,P=0.001）.The variation of Qa and CO were significantly greater in patients having ultrafiltration volume of 〉5% dry body weight than in those having ultrafiltration volume of〈 5% dry body weight（P〈0.05）.Conclusion Qa,CO and MAP were relatively stable in a hemodialysis session.Qa was positively correlated with CO and MAP.The increase of ultrafiltration volume in a session may result in the changes of Qa and CO and thus interfere with the stability of hemodynamics.