Kmentova Tereza, Valerianova Anna, Kovarova Lucie, Lachmanova Jana, Hladinova Zuzana, Malik Jan
1 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
2 Department of Nephrology, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
J Vasc Access. 2018 Nov;19(6):573-577. doi: 10.1177/1129729818763287. Epub 2018 Mar 15.
: Creation of vascular access leads to considerable local haemodynamic changes with decreased hand perfusion. Distal limb tissues then represent a model of hand ischaemia effect on muscles. The aim of our study was to investigate how the presence of vascular access influences the hand muscle strength in end-stage renal disease patients.
: We included 52 chronically haemodialysed patients with upper limb access without clinical signs of hand ischaemia. Muscle strength was evaluated by dynamometry. Finger pressure was measured on the second and fourth fingers and averaged for further analysis. Thenar tissue oxygenation (rSO) was analysed using near-infrared spectroscopy. All examinations were performed in both the hands. Basic laboratory analysis was added. Data were processed with unpaired t-test and correlation analysis.
: Hands with dialysis access had lower values of handgrip strength (54.2 ± 29.1 lbs vs 48.6 ± 23.4 lbs, p = 0.0006), systolic finger pressure (127.1 ± 32.0 mmHg vs 101.4 ± 31.6 mmHg, p < 10) and of thenar rSO (45.8% ± 12.9% vs 42.5% ± 13.3%, p = 0.002). Muscle strength (handgrip) was directly related to the thenar oxygenation ( r = 0.36; p = 0.014) and to the finger systolic pressure ( r = 0.38; p = 0.007) on the access extremity. On the extremity without dialysis access, handgrip strength was inversely related to patient's age ( r = -0.41, p = 0.003), dialysis vintage ( r = -0.32, p = 0.02) and red cell distribution width ( r = -0.37, p = 0.01).
: The presence of dialysis access leads to the decrease of finger pressure, oxygenation, and also muscle strength even in the absence of clinically overt hand ischaemia. All these parameters are interrelated. This study underlines the consequences of inadequate muscle perfusion.
建立血管通路会导致显著的局部血流动力学变化，手部灌注减少。肢体远端组织因此成为手部缺血对肌肉影响的一个模型。我们研究的目的是调查血管通路的存在如何影响终末期肾病患者的手部肌肉力量。
我们纳入了52例接受上肢血管通路慢性血液透析且无手部缺血临床体征的患者。通过握力计评估肌肉力量。测量第二和第四指的指压并取平均值用于进一步分析。使用近红外光谱分析鱼际组织氧合（rSO）。所有检查均在双手进行。增加了基本实验室分析。数据采用非配对t检验和相关性分析进行处理。
有透析血管通路的手，其握力值较低（54.2±29.1磅对48.6±23.4磅，p = 0.0006）、收缩期指压较低（127.1±32.0 mmHg对101.4±31.6 mmHg，p < 0.001）以及鱼际rSO较低（45.8%±12.9%对42.5%±13.3%，p = 0.002）。肌肉力量（握力）与血管通路侧的鱼际氧合（r = 0.36；p = 0.014）和指收缩压（r = 0.38；p = 0.007）直接相关。在无透析血管通路的一侧，握力与患者年龄（r = -0.41，p = 0.003）、透析龄（r = -0.32，p = 0.02）和红细胞分布宽度（r = -0.37，p = 0.01）呈负相关。
即使在无临床明显手部缺血的情况下，透析血管通路的存在也会导致指压、氧合以及肌肉力量下降。所有这些参数都是相互关联的。本研究强调了肌肉灌注不足的后果。
