中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (12): 835-838.doi: 10.3969/j.issn.1671-4091.2018.12.011

• 血管通路 • 上一篇    下一篇

维持性血液透析患者内瘘流量监测及危险因素分析

郑茜子1,段秀芳1,王晋伟1,许戎1,金其庄1   

  1. 1. 北京大学第一医院肾内科北京大学肾脏病研究所卫生部肾脏疾病重点实验室
  • 收稿日期:2018-06-25 修回日期:2018-09-26 出版日期:2018-12-12 发布日期:2018-12-19
  • 通讯作者: 金其庄 jinqizhuang@bjmu.edu.cn E-mail:jinqizhuang@bjmu.edu.cn

Factors associated with access blood flow in maintenance hemodialysis patients

  • Received:2018-06-25 Revised:2018-09-26 Online:2018-12-12 Published:2018-12-19

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摘要： 【摘要】目的  监测维持性血液透析患者内瘘流量并探讨其危险因素。方法 使用超声稀释法测定内瘘流量(access flow，Qa)，再循环率及心输出量(cardiac output, CO)，并结合多普勒超声及临床资料进行相关分析。结果共117 例患者纳入本研究，平均Qa(896±454)ml/min，21 例(17.9%)Qa＜500ml/min，85 例(72.6%) Qa 为500 ～ 1500ml/min，11 例 (9.4%) Qa ＞ 1500ml/min。与非糖尿病组相比，糖尿病组患者Qa 更低 (t = 4.615, P＜0.001)，内瘘狭窄的发生率更高(t=5.356，P=0.029)。Logistic 回归显示糖尿病(OR=8.782,95% CI：1.862～41.412，P=0.006)和内瘘既往手术史(OR=4.087, 95% CI：1.082～15.437，P=0.038)是低Qa 的独立危险因素。结论糖尿病是内瘘低流量最重要的独立危险因素，可能预示着内瘘预后不良。合并糖尿病的透析患者可能需要更为密切的监测内瘘功能，但尚需前瞻性研究进一步验证。

关键词: 血液透析, 超声稀释法, 血管通路, 通路流量, 糖尿病

Abstract: 【Abstract】Objective The aim of this cross-sectional study was to investigate clinical factors associated with access blood flow in maintenance hemodialysis (MHD) patients. Methods Ultrasound dilution (UD) was used to measure access flow (Qa), recirculation rate and cardiac output (CO). Multivariate logistic regression was performed to evaluate the contribution of the variables on access flow. Results A total of 117 MHD patients were included in this study. Their mean Qa was 896±454 ml/min. UD measurements classified 21 cases (17.9%) having Qa ＜500 ml/min, 85 cases (72.6%) having Qa 500~1,500 ml/min, and 11 cases (9.4%) having Qa ≥1,500 ml/min. Patients with diabetes had significantly lower Qa (t=4.615, P＜0.001) and higher prevalence of stenosis (t=5.356, P=0.029). Logistic regression analyses showed that diabetes history (OR 8.782, 95% CI: 1.862～41.412, P=0.006) and previous access surgery (OR 4.087, 95% CI: 1.082～15.437, P=0.04) were independently associated with lower access flow (Qa＜500 ml/min). Conclusions History of diabetes is the most important independent risk factor for lower access flow in MHD patients and may indicate long-term poor access patency. Access flow surveillance may be helpful in these patients. A prospective cohort study is on our schedule to further validate the findings from this study.

Key words: Hemodialysis, Ultrasound dilution, Vascular access, Access flow, Diabetes