在线监测血液透析过程中血流速对心功能的影响

目的 通过在线监测心脏相关指数及外周血管阻力,了解血液透析过程中提高泵控血流速 (Blood flow rate,BFR)对心脏功能的影响.方法 选择北京协和医学院肾内科采用自体动静脉内瘘,且内瘘流量＞600ml/min的规律血液透析患者34例,男性21例,女性13例,平均年龄为(55.06±13.20)岁(22～75岁).于透析开始后30～60min内,应用超声稀释技术监测BFR 200ml/min、250ml/min及300ml/min)对心输出量(Cardiac output,CO)、心脏指数(cardiac index,CI)、中心血容量(central blood volume,CBV)、中心血容量指数(central blood volume Index,CBVI)、外周阻力(peripheral resistance,PR)等参数的影响.结果 采用one-way ANOVA方差分析及配对t检验,BFR 200ml/min、250ml/min、300ml/min各流速时,患者CO、CI、CBV、PR、CBVI、系统心搏量指数及心搏出量均无明显统计学差异.结论 透析机泵控BFR 200～300ml/min范围内增加血流速对血液透析过程中心脏功能无明显影响.

Online monitoring the effect of blood flow rate on cardiac function in patients during hemodialysis

Objective To evaluate whether higher blood pump flow rate （BFR） influences the cardiac function during hemodialysis of chronic renal failure by online monitoring cardiac parameters and peripheral resistance.Methods The study subjects consisted of 34 regular hemodialysis patients （21 males and 13 females） using arteriovenous fistula with blood flow more than 600ml/min.Mean age of patients was 55.06±13.20 （22～75） years old.Cardiac output （CO）,cardiac index （CI）,central blood volume （CBV）,central blood volume Index （CBVI）,and peripheral resistance were measured by the ultrasound dilution technique within 30 to 60minutes after the beginning of hemodialysis sessions.Three levels of blood flow rates,200ml/min,250ml/min and 300ml/min,were selected to test the effect of different BFR on cardiac function.Results The parameters about cardiac function and peripheral resistance were not significantly different among three levels of BFR tested by one-way ANOVA and paired t-test.Conclusion Increasing BFR within 200～300ml/min didn＇t have adverse effect on cardiac function during hemodialysis in patients with chronic renal failure.It would be safe and well tolerant to increase BFR up to 300ml/min in most of patients in hemodialysis.