Garland Jocelyn S, Moist Louise M, Lindsay Robert M
Optimal Dialysis Research Unit and The University of Western Ontario, London, Ontario, Canada.
Adv Ren Replace Ther. 2002 Apr;9(2):91-8. doi: 10.1053/jarr.2002.33523.
Maintenance of vascular access function is vital to the delivery of adequate hemodialysis therapy. Failure of function is associated with significant morbidity and cost. Thus, access surveillance programs are suggested. The most common cause for access dysfunction is stenosis formation within the graft fistula. This may lead to reduced blood flow. The measurement of access blood flow has thus been recommended as the preferred method for surveillance. This article reviews blood flow among other methods for the screening of access dysfunction, the techniques used to measure it, the predictability of access flow measurements in determining the presence of access stenosis and allowing successful; intervention and finally the cost-effectiveness of such surveillance. Review of available evidence would suggest that access flow measurements are the best tests currently available to screen for access dysfunction, and as preventative interventions, such as angioplasty and surgery, are successful, they should be regarded as the present standard of care. This would appear to be a cost-effective strategy. Furthermore, the method of choice for access flow measurement is by ultrasound dilution technology.
维持血管通路功能对于提供充分的血液透析治疗至关重要。功能衰竭与显著的发病率和成本相关。因此，建议开展通路监测项目。通路功能障碍最常见的原因是移植动静脉内瘘形成狭窄。这可能导致血流量减少。因此，推荐测量通路血流量作为监测的首选方法。本文回顾了用于筛查通路功能障碍的血流量及其他方法、测量血流量的技术、通路血流量测量在确定通路狭窄存在及实现成功干预方面的可预测性，以及此类监测的成本效益。对现有证据的回顾表明，通路血流量测量是目前筛查通路功能障碍的最佳检测方法，并且由于血管成形术和手术等预防性干预措施取得成功，它们应被视为当前的护理标准。这似乎是一种具有成本效益的策略。此外，通路血流量测量的首选方法是超声稀释技术。
