维持性血液透析患者动静脉内瘘的测定

目的通过对维持性血液透析患者动静脉内瘘进行测定，以了解患者内瘘的再循环、流量及心排出量情况，为拟定透析方案提供依据。方法对73例患者在透析血液透析开始后0．5h及结束前0．5h进行内瘘测定，并对内瘘流量（AF）过低（AF〈600ml／min）进行追踪。结果73例中1例患者出现再循环，且再循环率大于50％，其余没有发生再循环者。15例患者流量〈600ml／min，占20．5％；18例〉1600m]／min，占24．7％。对〈600ml／min的15例患者追踪1年，其中6例堵塞，占40％；7例仍保持通畅，占46．7％；2例行肾移植。对开始后0．5h及结束前0．5h测定的AF、心排出量（CO）、心脏指数（CI）及中央血容量（CBV）比较差异均有统计学意义（P〈0．05或P〈0．01）。结论定期内瘘测定对患者的内瘘功能有预测作用，流量越低内瘘闭塞的可能性越大。自体动静脉内瘘血流量足的情况下，再循环率低，两点距离不是再循环重要因素。

Detection of the internal arteriovenous fistulas in maintenance hemodialysis patients

Objective To detect the internal arteriovenous fistulas (AVF) in 73 maintenance hemedialysis patients, as to explore the recirculation, blood flow and cardiac output of the internal AVF and provide basis for the hemodialysis project. Methods Internal AVF of 73 maintenance hemodialysis patients was detected 30 minutes after the initiation and 30 minutes before the end of the hemodialysis. Patients with low blood flow ( AF < 600 ml/min) were followed up. Results Fistula function was successfully monitored in 73patients, in which 1 case ( 1. 4% ) was found to have recirculation rate > 50%. 15 patients (20. 5% ) had AF <600 ml/min and 18 patients (24.7%) had AF > 1 600 ml/min. During 12 months follow up with the 15 patients (AF <600 ml/min), 6 cases (40%) had occlusion, 7 cases (46.7%) maintained unobstructed and 2 cases underwent kidney transplant. There was statistical significance in terms of internal fistula flow, cardiac output, cardiac index and center blood volume between 30 minutes after the initiation and 30 minutes before the end of the hemodialysis. Conclusions AVF detection plays an important role in the monitor of AVF function in hemodialysis patients. The possibility of AVF occlusion increases in patients with lower blood flow. The recirculation rate is low when AVF obtains enough blood flow and the internal fistula interval is not a major factor.