泵前动脉压与泵控血流速比值的绝对值对自体动静脉内瘘功能的预测研究

Prediction of absolute value of ratio of prepump pressure to blood flow rate to function of autogenous arteriovenous fistulas

目的:明确泵前动脉压与泵控血流速比值的绝对值(|Pa/Qb|)对自体动静脉内瘘(AVF)功能不良的影响及其安全范围,探究|Pa/Qb|的影响因素。方法:回顾性分析2018年1月—2019年1月3所三级甲等医院血液透析中心490例长期血液透析病人临床资料,评估|Pa/Qb|与AVF功能不良的关系,探究|Pa/Qb|的影响因素。结果:490例病人中有85例病人发生AVF功能不良。限制性立方样条显示,|Pa/Qb|与AVF功能不良风险存在U形关联(P<0.001)。当|Pa/Qb|为0.30~0.52时,AVF功能处于安全范围。线性回归分析显示,|Pa/Qb|与平均动脉压、年龄呈负相关,与β_(2)微球蛋白浓度、血红蛋白浓度呈正相关(P<0.05)。结论:当|Pa/Qb|<0.30或|Pa/Qb|>0.52时,AVF功能不良风险显著增加,应重新评估病人的AVF功能。此外,|Pa/Qb|监测可帮助护士判断泵控血流速设置的合理性以及识别不良事件,防止AVF功能进一步恶化,延长AVF的使用寿命。

Objective:To clarify influence of absolute value of ratio of prepump pressure to blood flow rate(|Pa/Qb|)to dysfunction of autogenous arteriovenous fistulas(AVF)and its safety range,and to explore influencing factors of|Pa/Qb|.Methods:Clinical information of 490 patients undergoing long-term hemodialysis in hemodialysis centers of 3 tertiary grade A hospitals from January 2018 to January 2019 were analyzed retrospectively.Relationship between|Pa/Qb|and AVF dysfunction was evaluated.Influencing factors of|Pa/Qb|were explored.Results:85 of 490 patients had AVF dysfunction.Restricted cubic splines revealed U-shaped association between|Pa/Qb|and risk of AVF dysfunction(P<0.001).When|Pa/Qb|was from 0.30 to 0.52,AVF function was in the safe range.Linear regression analysis showed that|Pa/Qb|was negatively correlated with mean arterial pressure and age,and positively correlated withβ_(2)-microglobulin concentrations and hemoglobin concentrations(P<0.05).Conclusions:When|Pa/Qb|<0.30 or|Pa/Qb|>0.52,risk of AVF dysfunction is significantly increased,and patient's AVF function should be reassessed.In addition,|Pa/Qb|monitoring can help nurses judge rationality of blood flow rate setting and identify adverse events,prevent further deterioration of AVF function,and prolong life of AVF.