Heerwagen Søren T, Hansen Marc A, Schroeder Torben V, Ladefoged Søren D, Lönn Lars
Department of Interventional Radiology, Rigshospitalet, Copenhagen, Denmark.
J Vasc Access. 2012 Apr-Jun;13(2):145-51. doi: 10.5301/jva.5000007.
To test the clinical performance of catheter-based thermodilution and Doppler ultrasound of the feeding brachial artery for blood flow measurements during hemodialysis vascular access interventions.
Thirty patients with arteriovenous fistulas who underwent 46 interventions had access blood flow measured before and after every procedure. Two methods, catheter-based thermodilution and Doppler ultrasound, were compared to the reference method of ultrasound dilution. Catheter-based thermodilution and Doppler ultrasound were performed during the endovascular procedures while flow by ultrasound dilution was determined within three days of the procedure. The methods were compared using regression analysis and tested for systematic bias.
Failure to position the thermodilutional catheter correctly was observed in 8 out of 46 (17%) pre-intervention measurements. Post-intervention measurements and ultrasound measurements were feasible in all patients. The average level of agreement was good when comparing catheter-based thermodilution to ultrasound dilution. However, blood flow by ultrasound dilution may differ by ±130 mL/min (±22%) at a flow level of 600 mL/min by thermodilution. Results from Doppler ultrasound displayed a moderate level of agreement on average when compared to ultrasound dilution. Blood flow by ultrasound dilution may differ by ±160 mL/min (±27%) at a flow level of 600 mL/min by Doppler ultrasound. No systematic bias was detected by either method.
On average, results from catheter-based thermodilution were more in agreement with results from the ultrasound dilution technique compared to Doppler ultrasound. However, considering the cost and the high technical failure rate of the thermodilutional system, we recommend the use of ultrasound.
测试基于导管的热稀释法和用于测量血液透析血管通路干预期间肱动脉血流量的多普勒超声的临床性能。
30例患有动静脉内瘘的患者接受了46次干预，每次操作前后均测量通路血流量。将基于导管的热稀释法和多普勒超声这两种方法与超声稀释参考方法进行比较。在血管内操作期间进行基于导管的热稀释法和多普勒超声检查，而超声稀释法测定的血流量在操作后三天内进行。使用回归分析比较这些方法，并测试系统偏差。
在46次干预前测量中，有8次（17%）观察到热稀释导管位置不正确。所有患者干预后测量和超声测量均可行。将基于导管的热稀释法与超声稀释法进行比较时，平均一致性水平良好。然而，在热稀释法测得血流量为600 mL/min时，超声稀释法测得的血流量可能相差±130 mL/min（±22%）。与超声稀释法相比，多普勒超声的结果平均显示出中等程度的一致性。在多普勒超声测得血流量为600 mL/min时，超声稀释法测得的血流量可能相差±160 mL/min（±27%）。两种方法均未检测到系统偏差。
平均而言，与多普勒超声相比，基于导管的热稀释法的结果与超声稀释技术的结果更一致。然而，考虑到热稀释系统的成本和高技术故障率，我们建议使用超声。
