摘要
目的:探讨维持性血液透析患者的动静脉内瘘血流量(arteriovenous fistula blood flow,AVFB)与心功能,尤其是右心功能之间的关系,为动静脉内瘘手术提供更合理的理论依据。方法:选取2018年01月~2018年12月在本中心使用自体动静脉内瘘进行维持性血液透析、符合入组条件的患者。收集患者的一般资料包括性别、年龄、透析龄、原发病、BMI等。记录实验室指标包括血红蛋白、肾功、血脂、离子、甲状旁腺素等。采用美国飞利浦IE33型彩色多普勒超声心动仪行心脏超声检查,记录左室内径(LVD)、右室内径(RVD)、左室后壁厚度(LVPW)、三尖瓣环收缩期位移(TAPSE)、三尖瓣反流速度(TRVmax)、肺动脉收缩压(PASP)、射血分数(EF)、E/A、平均E/e’等指标。以EF值评价左室收缩功能,以E/e’评价左室舒张功能。以TAPSE评价右室收缩功能。PASP≥35 mm Hg、TRVmax≥2.8 m/s诊断肺动脉高压(PAH)。采用美国GE公司LOOGIQ7彩色多普勒超声诊断仪行上肢动静脉血管超声,记录头静脉、肱动脉、桡动脉、尺动脉的内径及流速。计算AVFB(ml/min)=π×(头静脉内径/2)2×头静脉流速。采用SPSS 13.0进行统计学分析,P<0.05表示差异有统计学意义。结果:本研究共纳入113例患者,男68例,女45例,平均年龄(59.9±12.2)岁,平均透析龄(39.7±48.8)个月。按照测得的AVFB四分位法将患者分为4组,A组:AVFB≤623 ml/min,B组:623<AVFB≤883 ml/min,C组:883<AVFB≤1429 ml/min,D组:AVFB>1429 ml/min。研究发现:(1)AVFB最高组透析龄显著长于其他三组(P<0.05);(2)AVFB与TAPSE存在显著负相关(P=0.001,OR=-0.564),与PAH发生存在正相关(P=0.001,OR=0.262),与EF值、E/e’之间无显著相关性(P>0.05)。(3)Logistic回归分析显示,AVFB和透析龄是发生PAH的独立危险因素(P<0.05)。结论:对于维持性血液透析患者,AVFB的升高会导致右心收缩功能减低和肺动脉高压发生率的升高。因此应注意对动静脉内瘘血流量的监测和调控,以减少对右心收缩功能的影响、减少肺动脉高压的发生。
Objective:To explore the relationship between the arteriovenous fistula blood flow(AVFB)and heart function,especially the right heart function,in order to provide a more reasonable basis for the operation of arteriovenous fistula.Methods:From January 2018 to December 2018,the patients who met the admission conditions were selected for maintenance hemodialysis with AVF in our center.The general data of patients were collected,including gender,dialysis age,primary disease,BMI,etc.The laboratory indexes include hemoglobin,renal function,blood lipid,ion,parathyroid hormone,etc.The left ventricular diameter(LVD),right ventricular diameter(RVD),left ventricular posterior wall thickness(LVPW),tricuspid annular plane systolic excursion(TAPSE),tricuspid regurgitation velocity(TRVmax),pulmonary artery systolic pressure(PASP),ejection fraction(EF),E/A and mean E/e’were recorded by using Philips ie33 color Doppler echocardiography.Left ventricular systolic function was evaluated by EF and diastolic function by E/e’.TAPSE was used to evaluate right ventricular systolic function.PAH was determined by PASP≥35 mm Hg and TRVmax≥2.8 m/s.The diameter and velocity of cephalic vein,brachial artery,radial artery and ulnar artery were recorded.AVFB(m L/min)=π×(diameter of cephalic vein/2)2×velocity of cephalic vein.Statistical analysis using SPSS 13.0.P<0.05 showed significant difference.Results:A total of 113 patients were enrolled in this study,68 males,45 females,the average age was(59.9±12.2)years,average dialysis age was(39.7±48.8)months.Group A:AVFB≤623 ml/min,group B:623<AVFB≤883 ml/min,group C:883<AVFB≤1429 ml/min,group D:AVFB>1429 ml/min.The results showed that:(1)The dialysis age in the highest AVFB group was significantly longer than that in the other three groups(P<0.05);(2)There was a significant negative correlation between AVFB and TAPSE(P=0.001,OR=-0.564),a positive correlation with PAH(P=0.001,OR=0.262),and no significant correlation with EF and E/e’(P>0.05).(3)Logistic regression analysis showed that AVFB and dialysis age were independent risk factors for PAH(P<0.05).Conclusion:For maintenance hemodialysis patients,the increase of AVFB will lead to the decrease of right ventricular systolic function and pulmonary hypertension.Therefore,we should pay attention to the monitoring and regulation of the blood flow of the arteriovenous fistula,in order to reduce the impact on the right ventricular systolic function and the occurrence of pulmonaryhypertension.
作者
肖佳
赵华
刘书馨
XIAO Jia;ZHAO Hua;LIU Shuxin(Department of Nephrology,Dalian Central Hospital,Dalian 116033)
出处
《中国中西医结合肾病杂志》
2020年第5期403-407,共5页
Chinese Journal of Integrated Traditional and Western Nephrology
基金
辽宁省自然科学基金资助项目(No.201602219).
关键词
动静脉内瘘
血液透析
心功能
肺动脉高压
Arteriovenous fistula
Hemodialysis
Cardiac function
Pulmonary hypertension
