连续监测自体动静脉内瘘流量及再循环率对血液透析病人的影响

Influence of continuous monitoring of flow and recirculation rate of autologous arteriovenous fistula on hemodialysis patients

[目的]了解血液透析病人连续监测自体动静脉内瘘流量及再循环率的临床意义,为动静脉内瘘的临床管理提供理论依据。[方法]选择采用自体动静脉内瘘作为血管通路的72例维持性血液透析病人连续观察12个月,应用超声稀释技术每3个月对这些自体动静脉内瘘实际通路流量和再循环率进行1次检测,连续检测3次,然后随访6个月。观察期间记录自体动静脉内瘘在透析过程中实际的透析回路流量(Qa)、透析时的再循环率(AR)、动静脉内瘘流量(AF)、心输出量(CO)。[结果]所有参与研究的病人中,72例完成了第1次、第2次的内瘘监测,70例完成了第3次的数据测量,有2例病人因内瘘闭塞而改用中心静脉导管透析退出随访。在12个月的连续监测过程中病人AF值为256mL/min^2 340mL/min(888mL/min±419mL/min),第1次5例病人AR>5%,这5例病人AF值均<500mL/min(256mL/min^490mL/min),到随访结束时均发生了栓塞。3次AF值比较差异无统计学意义。72例病人动静脉内瘘在随访结束时共发生栓塞18例,发生栓塞的18例病人3次监测的平均AF值为709 mL/min±337mL/min,未发生栓塞的54例病人3次监测的平均AF值为1 171mL/min±692 mL/min;栓塞组和未发生栓塞组病人AF值及再循环率比较差异有统计学意义(P<0.05)。[结论]连续监测自体动静脉内瘘流量及再循环率对内瘘栓塞风险有很好的预测价值,是早期诊断通路功能不良、早期发现栓塞的有效工具。

Objective：To know about the clinical significance of continuous monitoring of the flow and the recirculation rate of the autologous arteriovenous fistula of hemodialysis patients,so as to provide a theoretical basis for the clinical management of arteriovenous fistula.Methods：A total of 72 cases of maintenance hemodialysis patients who took the autologous arteriovenous fistula as the vascular access were selected for observation for 12 consecutive months,and the flow and recirculation rate of these practical accesses were detected by ultrasonic dilution technique every 3months,consecutive detection for 3times,and then to follow up for 6months.During the observation period,the actual dialysis circuit（Qa）,recirculation rate（AR）,arteriovenous fistula flow（AF）,cardiac output（CO）were recorded during the hemodialysis.Results：All the patients involved in the study,72 cases completed internal fistula monitoring of the first round and second round,70 cases completed the data measurement in the third round.There were two cases of patients switching to central venous catheter dialysis and exiting follow-up because of internal fistula occlusion.During 12 months of continuous monitoring,the AF value of patients was 256mL/min to 2 340mL/min（888mL/min±419mL/min）,5cases of patients with AR5%in first round,the AF value of the 5patients was less than 500mL/min（256mL/min-490mL/min）,and the embolism occurred in them at the end of follow-up.There was no statistically significant difference in AF value among the 3rounds.In 72 cases of patients with arteriovenous fistula,there were 18 cases embolism occurred at the end of the follow-up.In the 18 cases with embolism the mean AF value was 709mL/min±337mL/min in3 rounds,mean AF value of 54 cases patients with no embolism was 1 171mL/min±692 mL/min;there was statistically significant difference in the AF and recirculation rate between embolism group and no-thrombosis group（P〈0.05）.Conclusion：Continuous monitoring of flow and recirculation rate of autologous arteriovenous fistula had good predictive value for the risk of internal fistula embolization.It was an effective tool of early diagnosis of access dysfunction and early detection of embolism.