Kleinekofort W, Kraemer M, Rode C, Wizemann V
Fresenius Medical Care Deutschland GmbH, Research & Development, Bad Homburg, Germany.
Int J Artif Organs. 2002 Jan;25(1):45-50. doi: 10.1177/039139880202500108.
Prospective monitoring of static venous pressure is an established tool to detect outflow stenoses in a vascular access. However, with this method it is not possible to identify vascular stenoses which are localized between the arterial and venous dialysis needle. We describe a new approach based on both static arterial and venous extracorporeal pressures. Pressure data of 9 dialysis patients with normal vascular access function and 9 patients with stenotic access were analyzed. Extracorporeal pressure was found to depend on the position of the heart relative to the extracorporeal blood circuit. All patients with venous outflow stenoses had an elevated ratio of arterial and venous intra-access pressure to mean arterial pressure. In case of access stenosis between arterial and venous needle the ratio of venous pressure to mean arterial pressure was normal, and only the arterial pressure ratio was elevated. We conclude that combined arterial and venous intraaccess pressure measurement normalized by mean blood pressure detects venous stenosis as well as stenosis between the arterial and venous dialysis needle. To minimize the rate of access thrombosis both arterial and venous intra-access pressure should be monitored.
前瞻性监测静态静脉压是检测血管通路中流出道狭窄的一种既定方法。然而，用这种方法无法识别位于动脉和静脉透析针之间的血管狭窄。我们描述了一种基于静态动脉和静脉体外压力的新方法。分析了9例血管通路功能正常的透析患者和9例血管通路狭窄患者的压力数据。发现体外压力取决于心脏相对于体外血液循环的位置。所有静脉流出道狭窄的患者，其动脉和静脉通路内压力与平均动脉压的比值均升高。在动脉和静脉针之间存在通路狭窄的情况下，静脉压力与平均动脉压的比值正常，只有动脉压力比值升高。我们得出结论，通过平均血压标准化的动脉和静脉通路内压力联合测量可检测静脉狭窄以及动脉和静脉透析针之间的狭窄。为了使通路血栓形成率降至最低，应同时监测动脉和静脉通路内压力。
