动静脉内瘘血流量对血液透析患者心功能的影响

The Effect of Arteriovenous Fistula Blood Flow on Cardiac Function in Hemodialysis Patients

目的 探讨动静脉内瘘血流量(AVFB)对血液透析患者的心功能影响。方法 将2018年1月至2021年12月在我院肾脏内科接受AVF的60例血液透析患者纳入观察中。根据内瘘自然血流量(Qa)与心排血量(CO)比值分成高流量组和低流量组,对比不同组患者临床情况,并通过彩色多普勒超声测定内瘘术前、内瘘术后1个月、术后半年患者的心功能指标,包括LVDd、LVDs、CO、EF、E、A及E/A,并掌握透析期间内瘘失功和高危事件发生情况。结果 本组60例患者中,通过测定AVFB,低流量组27例,高流量组33例,两组患者的临床基本情况无统计学意义(P> 0.05)。通过测定,内瘘术前、术后1个月两组心功能指标CO、EF、LVDd、LVDs、E、A及E/A均无统计学意义(P> 0.05),在内瘘术后半年两组指标均有增高,且高流量组高于低流量组(P <0.05)。低流量组的内瘘失功、高危事件发生率均低于高流量组(P <0.05)。结论 在实施AVF的血液透析治疗过程中,应注意血流量的管控,预防血流量过大对患者心功能的影响,减少内瘘失功的发生率,提高AVF的应用效率。

Objective To investigate the effect of arteriovenous fistula blood flow(AVF) on cardiac function in patients undergoing hemodialysis.Methods Sixty hemodialysis patients who received AVF in the Department of Nephrology of our hospital from January 2018 to December 2021 were included in the observation.According to the ratio of natural blood flow(Qa) to cardiac output(CO) in the fistula,patients were divided into two groups high flow group and low flow group.The clinical conditions of patients in different groups were compared,and the cardiac function indicators of patients before fistula surgery,1 month after fistula surgery,and 6 months after surgery were measured by color Doppler ultrasound,including LVDd,LVDs,CO,EF,E,A,and E/A.The incidence of fistula failure and high-risk events during dialysis was also monitored.Results Among the 60 patients in this group,AVFB was measured,there were 27 cases in the low flow group and 33 cases in the high flow group,and there was no significant difference in clinical basic information between the two groups(P>0.05).Through measurement,there was no significant difference(P>0.05) in the cardiac function indicators CO,EF,LVDd,LVDs,E,A,and E/A between the two groups before and one month after internal fistula surgery.However,both groups showed an increase in indicators six months after internal fistula surgery,and the high flow group was higher than the low flow group(P<0.05).The incidence of internal fistula loss and high-risk events in the low traffic group were lower than those in the high traffic group(P<0.05).Conclusions In the process of implementing AVF for HD treatment,attention should be paid to blood flow control,preventing the impact of excessive blood flow on patient cardiac function,reducing the incidence of fistula failure,and improving the application efficiency of AVF.