上、下臂动静脉内瘘对血透患者心功能影响的对比研究

Compared Study of Cardiac Function in Dialysis Patients with Arteriovenous Fistula on Higher or Lower Extremity

目的 :比较血透患者上臂、下臂动静脉内瘘 (AVF)对心功能的影响。方法 :采用彩色多普勒超声检查测定血透患者上臂、下臂动静脉内瘘的血流量、左室射血分数 (EF)值 ) ,比较上臂、下臂动静脉内瘘造瘘前、造瘘后一年心功能的改变。结果 :2 0例中上臂内瘘 7例 ,瘘流量在 960～ 25 4 0 ml/ min之间 ,平均 175 0± 368.4 2 ml/ min;下臂内瘘 13例 ,瘘流量在 390～ 910 ml/ min之间 ,平均 65 0± 143.12 ml/ min。 2 0例中 ,3例于透析间期时有心衰发作 ,其中 2例为下臂内瘘、瘘流量为 690 ml/ min和 960 ml/ min;1例为上臂内瘘、瘘流量为 960 ml/ min。此 3例均于透析开始时已有心衰的临床表现 ,而且因经费不足 ,透析不规则。其余 17例透析间期均无心衰发作 (包括上臂瘘流量达到 2 4 10 ml/ min)。结论 :动静脉内瘘可导致高心输出性心衰 ,其发生与造瘘前心功能状态、透析的规则性有关。上。

Objective:To compared the effect of hemodialysis on the cardiac function in renal dialysis patients with Arteriovenous fistual (AVF) on higher or lower Extremity.Methods:The ejection fraction(EF) before and after AVF for a year and the blood flow of AVF were measured by color doppler flow image(CDFI).Results:7 cases of higher extremity AVF and 13 cases of lower extremity AVF were studied.Cardiac failure related to hemodialysis AVF were found in 3 cases which is characteristic with cardiac failure before the establishment of AVF and irregular dialysis.One case is related to higher extremity AVF and two case is related to lower extremity AVF.Conclusions:A haemodialysis fistula may be a factor in the development of cardiac failure.It is seen more often in patients with a limited myocardial reserve and irregular dialysis.There is no significant difference on the cardiac function between the higher and lower arteriovenous extremity fistula.