超声稀释法在血液透析血管通路功能评价中的初步应用

目的：探讨超声稀释法在血液透析血管通路功能评估中的临床应用价值,并观察血管通路血流量与患者心输出量的相关性。方法：选择在我院血液净化中心透析龄为3～6月的维持性血液透析患者82例,病情稳定,已排除急性活动性疾病,均采用自体动静脉内瘘作为血管通路。使用Transonic HD02型血液透析监护仪对患者的血管通路进行检测,随访期为6个月,分别监测内瘘再循环率、内瘘通路血流量及心输出量等,并观察血管通路血流量与患者心输出量的相关性。结果：（1）观察0个月,内瘘血流量平均为（994.41±434.98）ml/min,心输出量平均为（6.38±3.14）L/min;随访6个月后复测相关指标,血液透析患者的血管通路血流量和心输出量均有所下降,内瘘血流量平均为（961.19±420.92）ml/min,心输出量平均为（6.12±4.17）L/min,但观察6个月与0个月比较,无统计学差异（P〉0.05）;4例（4.88%）患者出现再循环,均大于5%。（2）观察0个月,血管通路狭窄的发生率为9.76%;观察6个月后,血管通路狭窄的发生率为26.83%,二者比较,血管通路狭窄的发生率有统计学差异（P〈0.05）。（3）血管通路血流量与心输出量呈正相关（P〈0.05）,提示患者低心输出量可能导致血管通路血流量的下降。结论：超声稀释法操作简便、非创伤侵入性、安全实用,适用于血液透析患者血管通路的功能评估,可以前瞻性监测血管通路血流动力学意义上的狭窄,具有临床应用价值。

Value of Ultrasound Dilution Technology in Function Evaluation of hemodialysis Vascular Access

Objective：To investigate the value of ultrasound dilution technology in function evaluation of hemodialysis vascular access, and explore the relationship between the blood flow of arteriovenous fistula and the cardiac output. Methods： Eighty-two patients were selected, who had undergone hemcdialysis for three to six months before the study and were through native arteriovenous fistula for hemodialysis. Re - circulation, blood flow of fistula and cardiac output of patients were measured by HD02 hemodialysis monitor 30 minutes after the initiation and 60 minutes before the end of hemodialysis session. Results：All patients had a safety examination. In the past six months,the average level of blood flow of artcriovenous fistula decreased from （994.41 ± 434.98）ml/min to （961.19 ± 420.92）ml/min,while the average level of cardiac output was also decreascd from （6.38 ± 3.14）L/min to （6.12 ± 4.17）L/min, but the changes were of no difference （P 〉0.05）. Fistula recirculation（ 〉5 % ） occurred in 4 patients（4.88% ）. In the past six months,the blood flow of fistula less than 500 ml/min was found in 22 patients （26.83%）, compared with those in 8 patients （9.76 % ） of the baseline （P 〈 0.05）. Low cardiac output was significantly correlated with the decrease of fistula blood flow （P〈 0.05）. Conclusion：Ultrasound dilution is a simple non invasive surveillance method for the hemodialysis vascular access and for the prediction of stenosis in fistulas.