Sombolos Kostas I, Christidou Fotini N, Bamichas Gerasimos I, Gionanlis Lazaros D, Karagianni Anna C, Anagnostopoulos Theodoros C, Natse Taïsir A
Renal Unit G. Papanikolaou General Regional Hospital, Thessaloniki, Greece.
Hemodial Int. 2006 Jan;10(1):88-93. doi: 10.1111/j.1542-4758.2006.01180.x.
We report a new and simple way that can reveal the presence of vascular access recirculation (VAR) in patients undergoing hemodialysis (HD). Acid-base and blood gas parameters (pH, pO(2), pCO(2), and HCO(3)) were measured in blood samples drawn from an arterial fistula needle before the initiation of HD and from arterial and venous lines simultaneously 5 min later, in 31 patients (group A). Vascular access recirculation was measured using the glucose infusion test (GIT) immediately after the withdrawal of the 5-min samples. The same study was repeated in 30 patients in whom HD lines were reversed (group B). A comparison with baseline (predialysis) values of an analysis of the arterial line in group A at 5 min revealed that pCO(2) increased by 1.14+/-2.5 mmHg and HCO(3) by 0.6+/-0.6 mM/L (p<0.02 and p<0.00001, respectively). The corresponding pO(2) and pH values did not show significant differences. Glucose infusion test at 5 min (GITa) was -0.058+/-0.03%. A comparison with baseline (predialysis) values of an analysis of the arterial line in group B at 5 min revealed that pCO(2) increased by 7.7+/-3.5 mmHg and HCO(3) by 2.9+/-1.0 mM/L (p<0.000001 in each case). The pH level was significantly lower in comparison with baseline values (p<0.00001), while pO(2) did not show a significant difference. Glucose infusion test at 5 min (GITb) was 12.0+/-6.1% (p<0.000001 in comparison with GITa values). Clinically significant VAR was defined as HCO(3) increment >1.8 mM/L, based on the receiver-operating characteristics curve, which showed a threshold value of HCO(3) increment >1.8 mmol/L as a predictor of GIT recirculation. Five minutes after the initiation of high-flux HD with a 0 ultrafiltration rate, there is a small increment in arterial HCO(3) values relative to predialysis values. Clinically significant VAR is present when this increment is higher than 1.8 mM/L.
我们报告了一种新的简单方法，可揭示接受血液透析（HD）患者的血管通路再循环（VAR）情况。在31例患者（A组）中，于HD开始前从动脉内瘘针采集血样，并在5分钟后同时从动脉和静脉管路采集血样，测量酸碱及血气参数（pH、pO₂、pCO₂和HCO₃）。在采集5分钟血样后立即使用葡萄糖输注试验（GIT）测量血管通路再循环。在30例HD管路反转的患者（B组）中重复相同研究。对A组5分钟时动脉管路分析的基线（透析前）值进行比较发现，pCO₂升高1.14±2.5 mmHg，HCO₃升高0.6±0.6 mM/L（分别为p<0.02和p<0.00001）。相应的pO₂和pH值无显著差异。5分钟时的葡萄糖输注试验（GITa）为-0.058±0.03%。对B组5分钟时动脉管路分析的基线（透析前）值进行比较发现，pCO₂升高7.7±3.5 mmHg，HCO₃升高2.9±1.0 mM/L（每种情况均为p<0.000001）。与基线值相比，pH水平显著降低（p<0.00001），而pO₂无显著差异。5分钟时的葡萄糖输注试验（GITb）为12.0±6.1%（与GITa值相比，p<0.000001）。基于受试者工作特征曲线，临床显著VAR定义为HCO₃增量>1.8 mM/L，该曲线显示HCO₃增量>1.8 mmol/L为GIT再循环的预测阈值。在以0超滤率开始高通量HD 5分钟后，动脉HCO₃值相对于透析前值有小幅升高。当该增量高于1.8 mM/L时，存在临床显著VAR。
