CAJ | 학술논문

[目的]了解血液透析病人连续监测自体动静脉内瘘流量及再循环率的临床意义,为动静脉内瘘的临床管理提供理论依据。[方法]选择采用自体动静脉内瘘作为血管通路的72例维持性血液透析病人连续观察12个月,应用超声稀释技术每3个月对这些自体动静脉内瘘实际通路流量和再循环率进行1次检测,连续检测3次,然后随访6个月。观察期间记录自体动静脉内瘘在透析过程中实际的透析回路流量(Qa)、透析时的再循环率(AR)、动静脉内瘘流量(AF)、心输出量(CO)。[结果]所有参与研究的病人中,72例完成了第1次、第2次的内瘘监测,70例完成了第3次的数据测量,有2例病人因内瘘闭塞而改用中心静脉导管透析退出随访。在12个月的连续监测过程中病人 AF值为256 mL/min~2340 mL/min(888 mL/min±419 mL/min),第1次5例病人AR>5%,这5例病人AF值均<500 mL/min(256 mL/min~490 mL/min),到随访结束时均发生了栓塞。3次AF值比较差异无统计学意义。72例病人动静脉内瘘在随访结束时共发生栓塞18例,发生栓塞的18例病人3次监测的平均 AF 值为709 mL/min±337 mL/min,未发生栓塞的54例病人3次监测的平均 AF值为1171 mL/min±692 mL/min；栓塞组和未发生栓塞组病人 AF值及再循环率比较差异有统计学意义(P<0.05)。[结论]连续监测自体动静脉内瘘流量及再循环率对内瘘栓塞风险有很好的预测价值,是早期诊断通路功能不良、早期发现栓塞的有效工具。
[목적]료해혈액투석병인련속감측자체동정맥내루류량급재순배솔적림상의의,위동정맥내루적림상관리제공이론의거。[방법]선택채용자체동정맥내루작위혈관통로적72례유지성혈액투석병인련속관찰12개월,응용초성희석기술매3개월대저사자체동정맥내루실제통로류량화재순배솔진행1차검측,련속검측3차,연후수방6개월。관찰기간기록자체동정맥내루재투석과정중실제적투석회로류량(Qa)、투석시적재순배솔(AR)、동정맥내루류량(AF)、심수출량(CO)。[결과]소유삼여연구적병인중,72례완성료제1차、제2차적내루감측,70례완성료제3차적수거측량,유2례병인인내루폐새이개용중심정맥도관투석퇴출수방。재12개월적련속감측과정중병인 AF치위256 mL/min~2340 mL/min(888 mL/min±419 mL/min),제1차5례병인AR>5%,저5례병인AF치균<500 mL/min(256 mL/min~490 mL/min),도수방결속시균발생료전새。3차AF치비교차이무통계학의의。72례병인동정맥내루재수방결속시공발생전새18례,발생전새적18례병인3차감측적평균 AF 치위709 mL/min±337 mL/min,미발생전새적54례병인3차감측적평균 AF치위1171 mL/min±692 mL/min；전새조화미발생전새조병인 AF치급재순배솔비교차이유통계학의의(P<0.05)。[결론]련속감측자체동정맥내루류량급재순배솔대내루전새풍험유흔호적예측개치,시조기진단통로공능불량、조기발현전새적유효공구。
Objective:To know about the clinical significance of continuous monitoring of the flow and the recir-culation rate of the autologous arteriovenous fistula of hemodialysis patients,so as to provide a theoretical basis for the clinical management of arteriovenous fistula.Methods:A total of 72 cases of maintenance hemodialysis patients who took the autologous arteriovenous fistula as the vascular access were selected for observation for 1 2 consecutive months,and the flow and recirculation rate of these practical accesses were detected by ultrasonic di-lution technique every 3 months,consecutive detection for 3 times,and then to follow up for 6 months.During the observation period,the actual dialysis circuit (Qa),recirculation rate(AR),arteriovenous fistula flow(AF), cardiac output(CO)were recorded during the hemodialysis.Results:All the patients involved in the study,72 ca-ses completed internal fistula monitoring of the first round and second round,70 cases completed the data meas-urement in the third round.There were two cases of patients switching to central venous catheter dialysis and exiting follow up because of internal fistula occlusion.During 1 2 months of continuous monitoring,the AF val-ue of patients was 256 mL/min to 2 340 mL/min (888 mL/min±419 mL/min),5 cases of patients with AR>5% in first round,the AF value of the 5 patients was less than 500 mL/min (256 mL/min~490 mL/min),and the embolism occurred in them at the end of follow up.There was no statistically significant difference in AF value among the 3 rounds.In 72 cases of patients with arteriovenous fistula,there were 18 cases embolism oc-curred at the end of the follow up.In the 18 cases with embolism the mean AF value was 709 mL/min±337 mL/min in 3 rounds,mean AF value of 54 cases patients with no embolism was 1 171mL/min±692 mL/min;there was statistically significant difference in the AF and recirculation rate between embolism group and no thrombosis group(P<0.05).Conclusion:Continuous monitoring of flow and recirculation rate of autologous ar-teriovenous fistula had good predictive value for the risk of internal fistula embolization.It was an effective tool of early diagnosis of access dysfunction and early detection of embolism.