摘要
目的检测血液透析过程中不同时间点内瘘流量的变化及患者血流动力学变化对其的影响,以探讨超声稀释法检测内瘘流量的合适时机。方法使用Transonic HD02型血液透析监测仪对49例应用自体动静脉内瘘的维持性血液透析患者在透析过程中30min、90min、150min及210min时内瘘流量(Qa)、心输出量(CO)、心脏指数(CI)等参数进行监测,观察Qa的变化趋势及血流动力学参数在不同时间点对Qa的影响。结果4个时间点测得的Qa和平均动脉压(MAP)校正后的内瘘流量(Qa’)无明显差别。Qa与MAP呈正相关,且透析过程中Qa的变化与MAP的变化呈正相关。各时间点的MAP均为该点Qa的独立影响因素。透析210min时超滤量大于干体重5%的患者Qa的变化显著大于超滤量小于干体重5%的患者。结论血液透析过程中的各个时段均可进行内瘘流量的检测,但是存在MAP显著下降时不宜进行Qa检测。此外,超滤量超过干体重5%的患者,不建议在透析150min后测定其内瘘流量。
Objective To consecutively measure the access flow （Qa） change in arteriovenous fistula during a hemodialysis session using ultrasound dilution technique in order to understand the appropriate period for Qa measurement in a hemodialysis session. Methods We consecutively monitored the parameters of Qa in arteriovenous fistula, cardiac output and cardiac index during a hemodialysis session at 30, 90, 150 and 210 minutes by using a Transonic HD02 hemodialysis monitor in 49 maintenance hemodialysis patients. The changes of Qa and the effect of hemodynamic changes on Qa were then evaluated. Results There were no significant differences among the average Qa values and the Qa values adjusted with mean arterial pressure （MAP）, which were measured at the 4 time points. Qa correlated positively with MAP, so did the change of Qa with the change of MAP in a hemodialysis session. MAP was the independent impact factor of its respective Qa at every time point. After a hemodialysis session for 210min, Qa change was significantly bigger in the patients with ultrafiltration volume more than 5% of their dry body weight than those with ultrafiltration volume less than 5% of their dry body weight. Conclusion Qa can be measured at any time in a hemodialysis session, but not suitable for patients with significantly lower MAP during hemodialysis. For patients with the ultrafiltration volume more than 5% of their dry body weight, Qa measurement was not recommended after 150min or longer in a hemodialysis session.
出处
《中国血液净化》
2010年第2期76-79,共4页
Chinese Journal of Blood Purification
关键词
动静脉内瘘
超声稀释技术
血液透析
Arteriovenous fistula
Ultrasound dilution technology： Hemodialysis
