HD02型血透监测仪对血液透析患者内瘘的监测

目的评价应用超声稀释法的HD02型血透监测仪对血液透析患者内瘘监测的效能。方法使用HD02型血透监测仪对90例长期维持性血液透析（MHD）患者在透析期间进行内瘘再循环、流量及心输出量等监测。分析影响内瘘流量的相关因素。结果4例患者出现再循环。占4．44％。且均大于5％（非尿素稀释法异常标准）。21例患者内瘘血流量〈500mL／min，占23．33％：3例〉2000ml／min，占3．33％。影响内瘘流量的Logistic回归分析显示，年龄、性别、透析时间、内瘘使用时间、平均动脉压均与内瘘流量下降无相关；低心输出量和糖尿病与内瘘流量下降相关。33例患者心输出量〈4L／min，占36．67％，提示部分患者在透析期间处于低心输出量状态。其中低心输出量的8例患者接受心脏彩色多普勒超声检查。均发现有不同程度的室间隔肥厚、瓣膜区钙化和反流、左室舒张功能不全等心血管功能和形态学改变。结论超声稀释法是一项操作简便、非侵入及实用的内瘘监测方法。自体动静脉内瘘在有足够血流情况下．再循环率低。低心输出量和糖尿病与内瘘流量下降相关。

Surveillance of arteriovenous fistula in hemodialysis patients using HD02 monitor

Objective To evaluate the efficacy of HD02 hemodialysis monitor by means of ultrasound dilution method in surveillance of arteriovenous fistula. Methods Re-circulation, blood flow of fistula and cardiac output of 90 maintenance hemodialysis (MHD) patients were measured by HD02 hemodialysis monitor during hemodialysis session. Concerning factors of fistula blood flow were analyzed. Results Fistula re-circulation(>5%) occurred in 4 patients (3.33%). Blood flow (Qa) less than 500 ml/min was found in 21 patients(23.33%), and more than 2000 ml/min in 3 patients (3.33%). The logistic regression analysis revealed that age, sex, time of hemodialysis, time of fistula creation and mean arterial pressure were not significantly correlated, but low cardiac output and diabetes were significantly correlated to the decrease of fistula blood flow. Cardiac output less than 4 L/min was found in 33 patients(36.67%), suggesting that low cardiac output status existed in some MHD patients during hemodialysis session. Cardiac color Doppler was performed in 8 low cardiac output status patients and the result showed changes of cardiac function and structure such as interventricular septum pachynsis, cardiac valve calcification, back-streaming and left ventricle diastolic insufficiency. Conclusions Ultrasound dilution is a simple non-invasive surveillance method for hemodialysis fistula. The re-circulation rate is low when A-V fistula obtaining enough blood flow.Low cardiac output and diabetes are significantly correlated with the decrease of fistula blood flow.