中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (11): 781-785.doi: 10.3969/j.issn.1671-4091.2017.011.017

• 血管通路 • 上一篇    下一篇

基于超声稀释法的血管通路监测在动静脉内瘘维护中的临床应用

余少斌1,周莉1,曾筱茜1,刘菁1,苟慎菊1,马良1,付平1   

  1. 1. 华西肾脏病研究室/四川大学华西医院肾脏内科
  • 收稿日期:2017-07-03 修回日期:2017-08-30 出版日期:2017-11-12 发布日期:2017-10-27
  • 通讯作者: 付平fupinghx@163.com E-mail:fupinghx@163.com
  • 基金资助:

    国家自然科学基金(NO.81570668)

The clinical application of ultrasound dilution technology for vascular access flow detection among maintenance hemodialysis patients

  • Received:2017-07-03 Revised:2017-08-30 Online:2017-11-12 Published:2017-10-27

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摘要： 目的探讨基于超声稀释法(ultrasound Dilution，UD)的血管通路监测在维持性血液透析(maintenance Hemodialysis，MHD)患者血管通路维护中的临床应用价值。方法回顾性分析2015 年1月～2016 年2 月于华西医院血液透析中心使用动静脉内瘘(arteriovenous Fistula，AVF)并利用HD02血液透析监测仪行UD 评估血管通路的MHD 患者213 例。记录AVF 患者首次采用UD 监测的实际血流量、内瘘流量(access flow，Qa)、心输出量(cardiac output，CO)、内瘘流量与心输出量的比例(Qa/CO)、心脏指数(cardiac index，CI)。评估基于UD 方法在AVF 低血流量相关因素分析、AVF 狭窄诊断和处理等方面的应用。结果①组间比较结果提示，与Qa≥500ml/min 的患者比较，Qa＜500ml/min 的患者AVF 血栓的发生率较高(38.235% 比11.173%；c2=15.983；P＜0.001)、血管狭窄的比例较高(20.588% 比1.676%；c2=22.840；P＜0.001); ②采用多元logistic 逐步回归对基于UD 方法测量的低血流量危险因素进行分析，结果提示，血管狭窄与AVF 流量不足独立相关[OR=14.192，95% CI 3.410～59.056,P＜0.001]。③针对AVF 狭窄进行干预后使用UD 复测内瘘实际流量及Qa，结果显示流量均较前升高。④UD 测量AVF 高流量的患者间隔＞1 年后复查左心室大小及左室射血分数无明显差异(t =- 0.424,P=0.681;t=0.497, P=0.631)。结论AVF 血栓及血管狭窄是Qa 的影响因素，其中血管狭窄与AVF 低血流量独立相关。使用UD 可有效地动态评估AVF 狭窄治疗干预前后的Qa 变化。基于UD 的血管通路监测有助于及时发现血管通路障碍，在MHD 患者血管通路维护中具有临床应用价值，下一步拟前瞻性队列研究进一步验证本研究结果。

关键词: 血液透析, 超声稀释法, 血管通路, 再循环率, 通路流量, 动静脉内瘘

Abstract: Objective The primary purpose of this study is to explore the clinical value of ultrasound dilution (UD) technology for vascular access flow detection among patients undergoing maintenance hemodialysis (MHD) by conducting a single-center retrospective study. Methods We retrospectively studied the clinical
characteristic data and detection results from Transonic HD02 hemodialysis monitor, collected from a cohort of 213 patients undergoing MHD longer than six months in our hemodialysis center. UD was applied to detect the blood flow, access flow (Qa), cardiac output (CO), Qa/CO, cardiac index (CI) in MHD patients with arteriovenous fistula (AVF). Results ①Comparative results from two independent samples grouped by access flow (Qa ＜500 ml/min vs. Qa ≥500ml/min) indicated that significantly higher prevalence of fistula thrombus and vascular stenosis could be found in patients with Qa＜500 ml/min when compared to those with Qa≥ 500ml/min (38.235% vs. 11.173%; c2=15.983; P＜0.001 and 20.588% vs. 1.676%; c2=22.840; P＜0.001, respectively),②Results from multivariate logistic regression analysis indicated that vascular stenosis was a significant risk factor for Qa insufficiency (OR=14.192, 95% CI 3.410～59.056, P＜0.001), while the associations of Qa insufficiency with age, diabetes mellitus and time of AVF use were insignificant; ③Both actual flow in fistula and Qa were significantly improved after the intervention towards AVF stenosis; ④For patients with Qa ≥500ml/min, no significant differences were found between baseline results and the figures one year later concerning left ventricular volume and left ventricular ejection fraction (t=-0.424, P=0.681; t=0.497, P=0.631). Conclusion For patients with AVF, AVF thrombus and vascular stenosis were associated with lower AVF flow, and notably vascular stenosis acted as an independent risk factor. It is of great clinical value to detect Qa based on UD technology among MHD patients to maintain vascular access, especially for effectively recognizing access dysfunction. A multi- center prospective cohort study based on a larger scale is on our schedule to further validate the findings from this study.

Key words: hemodialysis, ultrasound dilution, vascular access, access recirculation, access flow, arteriovenous fistula