不同泵控速度对维持性血液透析动静脉内瘘患者透析相关指标及心功能的影响

Effect of different pump control speed on dialysis-related indexes and cardiac function in patients with maintenance hemodialysis arteriovenous fistula

目的 探究不同泵控速度对维持性血液透析(MHD)动静脉内瘘(AVF)患者透析相关指标及心功能的影响。方法 收集2016年12月至2019年12月青海省第五人民医院收治的106例患者的临床资料,根据泵控血流量中位数进行分组,≤275 ml/min为低流量组,>275 ml/min为高流量组,各53例。比较两组患者的心功能指标、初级通畅率、透析效能、炎症因子水平、并发症发生率、高危事件及内瘘功能。结果 随访12个月后,低流量组初级通畅率为77.36%,与高流量组的75.47%比较,差异无统计学意义(P>0.05)。透析12个月后,两组患者的心功能指标[心排血量(CO)、心脏指数(CI)、射血分数(EF)]均高于透析3个月后,差异均有统计学意义(P<0.05);透析3、12个月后,两组患者的心功能指标比较,差异均无统计学意义(P>0.05)。低流量组患者血管通路血流量低于高流量组患者,差异有统计学意义(P<0.05)。两组患者尿素氮清除指数、尿素氮下降率比较,差异均无统计学意义(P>0.05)。透析12个月后,两组患者血清超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、β2微球蛋白(β2-MG)均低于透析3个月后,差异均有统计学意义(P<0.05);但两组间血清hs-CRP、IL-6、TNF-α、β2-MG水平比较,差异均无统计学意义(P>0.05)。随访1年后,两组患者并发症、高危事件和内瘘失功发生率比较,差异均无统计学意义(P>0.05)。结论 在AVF仪器说明书中要求的内瘘血流量600~1800 ml/min范围内,不同泵控速度对患者的透析相关指标及心功能指标的影响较小,临床医务人员应根据患者的个体情况选择合适的流速,以达到透析的充分性,从而进一步提高患者的生活质量。

Objective To explore the effect of different pump control speed on dialysis-related indexes and cardiac function in patients with maintenance hemodialysis(MHD) arteriovenous fistula(AVF). Method A total of 106 patients in the Fifth People’s Hospital of Qinghai Province from December 2016 to December 2019 were selected and divided into low flow group(≤275 ml/min) and high flow group(>275 ml/min) according to median pump control blood flow during dialysis,53 cases in each group. Cardiac function, primary patency rate, dialysis efficacy, levels of inflammatory factors, incidence of complications, high risk events and fistula function of two groups were compared. Result After 12 months of follow up,the primary patency rate in low flow group was 77.36%, which was not significantly different from 75.47% in high flow group(P>0.05). The cardiac function [cardiac output(CO), cardiac index(CI)], ejection fraction(EF)] after 12 months of dialysis was higher than those of after 3 months of dialysis(P<0.05);without significant difference for the cardiac function after 3 and 12 months of dialysis between the two groups(P>0.05). The blood flow in the low flow group was lower than that in the high flow group(P<0.05). There were no significant differences in urea nitrogen removal index and urea nitrogen reduction rate between two groups(P>0.05). The levels of hypersensitive C reactive protein(hs-CRP), interleukin-6(IL-6),tumor necrosis factor-α(TNF-α) and β2-microglobulin(β2-Mg) in two groups after 12 months of dialysis were lower than those of after 3 months of dialysis(P<0.05), without significant difference between two groups(P>0.05). After 1 year of follow up, there were no significant differences for the incidence of complications, high risk events and fistula dysfunctioning between two groups(P>0.05). Conclusion At 600-1800 ml/min of required internal fistula blood flow in AVF instrument specifications, different pump control speed has mild effect on dialysis related index and cardiac function for the patients,clinical medical personnel should choose individualized velocity to achieve the adequacy of dialysis and further improve the quality of life of patients.