泵控血流量对维持性血液透析患者心脏负荷和血管通路狭窄情况的影响

Impacts of pump-controlled blood flow on cardiac load and vascular access stenosis in patients on maintenance hemodialysis

目的探讨泵控血流量对维持性血液透析(MHD)患者心脏负荷和血管通路狭窄情况的影响。方法收集2019年4月至2020年4月于本院行MHD治疗的患者92例, 根据透析时泵控血流量的不同分为低血流量组(<220 ml/min)44例和高血流量组(≥220 ml/min)48例, 均持续透析治疗6个月。治疗后3个月及6个月, 记录两组血管通路狭窄情况。治疗前及治疗后6个月进行两组心脏负荷水平检测, 包括心肌做功指数(Tei指数)、左心室射血分数(LVEF)及每搏输出量(SV)。治疗前及治疗后6个月, 检测两组血清C反应蛋白(CRP)、肌酐(Cr)和血红蛋白(Hb)水平。记录透析期间内瘘失功能及高危事件等并发症发生情况。结果治疗后3个月两组血管通路狭窄率比较, 差异无统计学意义(P>0.05)。治疗后6个月, 低血流量组血管通路狭窄率为27.27%, 显著高于高血流量组的10.42%(P<0.05)。治疗前两组患者Tei指数、LVEF及SV组间比较, 差异均无统计学意义(均P>0.05)。治疗后6个月两组患者Tei指数、LVEF及SV较治疗前均显著升高, 且高血流量组Tei指数、LVEF及SV均显著高于低血流量组(均P<0.05)。治疗前及治疗后6个月, 两组血清CRP、Cr及Hb水平组间比较, 差异均无统计学意义(均P>0.05)。治疗后6个月两组患者血清CRP、Cr水平较治疗前均显著降低, Hb较治疗前均显著升高(均P<0.05)。低血流量组与高血流量组内瘘失功能发生率分别为25.00%(11/44)、8.33%(4/48), 低血流量组内瘘失功能发生率显著高于高血流量组(χ^(2)=4.67, P=0.031)。低血流量组高危事件发生率为13.64%, 显著低于高血流量组的31.25%(χ^(2)=4.04, P=0.044)。结论 MHD治疗时应根据临床选择合适的血流量, 减少并发症的发生并提高透析治疗效果。

Objective To investigate the impacts of pump-controlled blood flow on cardiac load and vascular access stenosis in patients on maintenance hemodialysis(MHD).Methods A total of 92 patients undergoing MHD in our hospital between April 2019 and April 2020 were recruited.According to the pump-controlled blood flow during hemodialysis,they were divided into the low blood flow group(<220 ml/min,n=44)and the high blood flow group(≥220 ml/min,n=48),both on continuous hemodialysis for 6 months.At 3 and 6 months of treatment,the two groups were recorded for vascular access stenosis.Before and at 6 months of treatment,cardiac load was measured for the two groups,including myocardial performance(Tei index),left ventricular ejection fraction(LVEF)and stroke volume(SV).Before and at 6 months of treatment,serum levels of C-reactive protein(CRP),creatinine(Cr)and hemoglobin(Hb)were examined for the two groups.Complications such as internal fistula dysfunction and high-risk events during hemodialysis were recorded.Results There was no significant difference in the rate of vascular access stenosis between the two groups at 3 months of treatment(P>0.05).At 6 months of treatment,the rate of vascular access stenosis was significantly higher in the low blood flow group than that in the high blood flow group(27.27%vs 10.42%,P<0.05).Before treatment,there were no significant differences in Tei index,LVEF and SV between the two groups(all P>0.05).At 6 months of treatment,the Tei index,LVEF and SV in either group were significantly increased compared with baseline,and these values were significantly higher in the high blood flow group than those in the low blood flow group(all P<0.05).Before and at 6 months of treatment,there were no significant differences in serum levels of CRP,Cr and Hb between the two groups(all P>0.05).At 6 months of treatment,the serum CRP and Cr levels were significantly lower,and the Hb level was significantly higher,compared with baseline,in either group(all P<0.05).The incidence of internal fistula dysfunction was 25.00%(11/44)in the low blood flow group vs 8.33%(4/48)in the high blood flow group,suggesting that the low blood flow group had significantly higher incidence of internal fistula dysfunction compared with the high blood flow group(χ^(2)=4.67,P=0.031).The incidence of high-risk events in the low blood flow group was 13.64%,which was significantly lower than 31.25%as in the high blood flow group(χ^(2)=4.04,P=0.044).Conclusion The level of blood flow should be properly selected according to clinical practice during MHD,so as to reduce complications and improve the therapeutic efficacy of hemodialysis.