肘部内瘘与腕部内瘘对维持性血液透析患者左心功能的影响

目的探讨肘部内瘘与腕部内瘘对维持性血液透析患者左心功能的影响。方法选择我院2007年1月至2010年6月维持性血液透析患者39例。血管通路为肘部内瘘者14例，为肘部内瘘组；血管通路为腕部内瘘者25例，为腕部内瘘组。比较2组左心室射血分数（EF）、短轴缩短率（FS）、左心房内径（LAD）、主动脉根部内径（AAo）、左心室舒张末期内径（LVDd）、左心室收缩末期内径（LVDs）、室间隔厚度（IVST）、左心室后壁厚度（LVPWT）、泵控血流量（Qb）及心脏舒张功能减退者比例E／A（〈1）％]。结果肘部内瘘组LVDd较腕部内瘘组降低（46．07±6．38）mm比（52．44±7．60）mm3（P〈0．05），而EF、FS、LAD、AAO、LVDs、IVST、LVPWT、Qb及E／A（〈1）％无差异（P〉0．05）。结论与腕部内瘘相比，肘部内瘘并没有明显影响左心结构，并不成为高输出量性心力衰竭的高危因素。因此，在腕部内瘘不成功的情况下，可选择肘部内瘘作为长期透析的血管通路。

Effects of elbow and wrist arteriovenous fistula on left cardiac function in maintenance hemodialysis patients

Objective To study the effects of elbow and wrist arteriovenous fistula on left cardiac function in maintenance hemodialysis patients. Methods Thirty-nine maintenance hemodialysis patients during Jan. 2007 to Jun. 2010 were enrolled in this study. Arteriovenous fistula was created at the elbow in 14 cases （elbow group）, and at the wrist in 25 cases （wrist group）. Left ventricular ejection fraction （EF）, shortening fraction （FS）, left atrium internal dimension CLAD）, aortic root internal dimension （AAo）, left ventricular end diastolic internal dimension （LVDd）, left ventricular end systolic internal dimension （LVDs）, interventricular septal thickness （IVST）, left ventricular posterior wall thickness （LVPWT）, pump controlled blood flow （Qb） and rate of patients for cardiac diastolic dysfunction E/A〈1）%] between two groups were compared. Results LVDd was lower in elbow group than in wrist group （46. 07±6. 38） mm vs （52. 44± 7. 60） mm]（P〈0. 05）. There was no significant difference in EF, FS, LAD, AAo, LVDs, IVST, LVPWT, Qb and E/A（〈1）% between two groups （P〉0. 05）. Conclusions The effects of two kinds of arteriovenous fistulae on the left cardiac structure are similar. Elbow arteriovenous fistula is not one of high risk factors for high output cardiac failure among maintenance hemodialysis patients. Elbow arteriovenous fistula is a reasonable alternative for maintenance hemodialysis access when wrist arteriovenous fistula is impossible.