血管通路建立前肱动脉僵硬度的测定：脉搏波速度评估的可重复性

Determination of brachial artery stiffness prior to vascular access creation: reproducibility of pulse wave velocity assessment.

作者信息

Bode Aron S, Leermakers Jaap, Kroon J Wilco, Brands Peter, Planken R Nils, Tordoir Jan H M

机构信息

Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.

出版信息

Nephrol Dial Transplant. 2012 Jun;27(6):2370-6. doi: 10.1093/ndt/gfr687. Epub 2011 Dec 20.

DOI:10.1093/ndt/gfr687

PMID:22189208

Abstract

BACKGROUND

Despite routine ultrasound mapping of upper extremity arteries and veins, early thrombosis and nonmaturation remain frequent complications following vascular access (VA) surgery. Besides vascular diameters, brachial artery stiffness is assumed to play an important role; however, reproducibility of measurements has never been established. The purpose of this study was to determine within-session and between-session variabilities of pulse wave velocity (PWV) assessment by using ultrasonography and blood pressure registration.

METHODS

Beat-to-beat changes in brachial artery diameter and pressure were obtained in 21 subjects in measurement sessions on Day 1 and Day 3. Each session consisted of three acquisitions. For each acquisition, systolic and diastolic diameter and pressure were determined and used for calculation of brachial artery PWV. Within-session variability of diameter and pressure, as well as the estimated PWV, was expressed using the intraclass correlation coefficient with corresponding coefficient of variation (CoV). Between-session variability was reported using Bland-Altman analysis in combination with CoV analysis.

RESULTS

Significant agreement (P < 0.001) was obtained for all diameter and pressure measurements obtained on Day 1 and Day 3. Within-session CoV of pulse pressure, diastolic diameter and distension were 7.0, 1.6 and 18.3%, respectively. Subsequent estimation of local PWV resulted in a CoV of 10.6%. Between-session CoV was 15.1, 3.8 and 18.9% for pulse pressure, diastolic diameter and distension, respectively. For PWV estimation, this resulted in a CoV of 13.5%.

CONCLUSIONS

Diameter and pressure can be recorded accurately over the cardiac cycle, and calculations of distensibility, pulse pressure and PWV show a slight to moderate degree of variation. Larger studies elaborating on interindividual differences need to determine the clinical efficacy of PWV measurements prior to VA creation.

摘要

背景

尽管上肢动脉和静脉的超声检查已成为常规操作，但血管通路（VA）手术后早期血栓形成和未成熟仍是常见的并发症。除血管直径外，肱动脉僵硬度也被认为起重要作用；然而，测量的可重复性从未得到证实。本研究的目的是通过超声检查和血压记录来确定脉搏波速度（PWV）评估在同一测量时段内和不同测量时段间的变异性。

方法

在第1天和第3天的测量时段内，对21名受试者的肱动脉直径和压力的逐搏变化进行了测量。每个测量时段包括三次采集。对于每次采集，确定收缩期和舒张期的直径和压力，并用于计算肱动脉PWV。直径和压力在同一测量时段内的变异性，以及估计的PWV，使用组内相关系数及相应的变异系数（CoV）表示。不同测量时段间的变异性通过Bland-Altman分析结合CoV分析进行报告。

结果

第1天和第3天获得的所有直径和压力测量值均具有显著一致性（P < 0.001）。脉搏压、舒张期直径和扩张度在同一测量时段内的CoV分别为7.0%、1.6%和18.3%。随后对局部PWV的估计得出CoV为10.6%。脉搏压、舒张期直径和扩张度在不同测量时段间的CoV分别为15.1%、3.8%和18.9%。对于PWV估计，这导致CoV为13.5%。