Rotondi Silverio, Tartaglione Lida, Muci Maria Luisa, Pasquali Marzia, Pirozzi Nicola, Mazzaferro Sandro
Nephrology and Dialysis Unit, ICOT Hospital, Polo Pontino Sapienza University of Rome, Italy.
Nephrology and Dialysis Unit, Policlinico Umberto I, Rome, Italy.
Clin Kidney J. 2019 Jun 1;13(2):184-187. doi: 10.1093/ckj/sfz064. eCollection 2020 Apr.
Doppler ultrasound (DU) monitoring early after arteriovenous fistula (AVF) creation allows the identification of low blood flow (Qa) requiring prompt revision, but it is costly (needs skilled operators and technical instruments) and is not available in all dialysis units. Therefore alternative first-line methods to measure Qa would be welcomed. We reasoned that once an AVF is created, an increment in central venous oxygen saturation (ScvO) is predictable and proportional to Qa.
Accordingly, in patients receiving dialysis through a central venous catheter (CVC) in whom an AVF was created, we measured, by means of blood gas analysis, the ScvO increment before and after manual compression of the arteriovenous shunt and verified its correlation with DU-measured Qa.
We sampled blood gas in 18 patients with CVC and AVF before and after 30 s manual compression of the AVF. ScvO averaged 70.5 ± 3% before and 65.2 ± 3% after AVF closure, with an average drop of 5.1 ± 3% (range 1-12). AVF Qa, which was measured within 24 h by means of DU, averaged 635 ± 349 mL/min (range 50-1300) and was strictly and positively correlated with ΔScvO ( 0.954, P < 0.0001).
Therefore we suggest that in patients with CVC and a newly created AVF, it is possible to monitor AVF Qa without DU by simply measuring blood gas and ΔScvO. This technique is simple, cheap, repeatable, non-invasive and operator independent and represents a new useful screening test to detect delayed AVF access maturation deserving prompt DU measurement and surgical revision. It helps to quickly identify patients in urgent need of DU verification and possible surgical revision. Regrettably, it is applicable only in patients with CVC.
动静脉内瘘（AVF）建立后早期进行多普勒超声（DU）监测可识别出需要及时修复的低血流量（Qa）情况，但该方法成本高昂（需要技术熟练的操作人员和专业技术仪器），且并非所有透析单位都具备。因此，人们期待有替代的一线方法来测量Qa。我们推断，一旦建立了AVF，中心静脉血氧饱和度（ScvO）的升高是可预测的，且与Qa成正比。
因此，对于通过中心静脉导管（CVC）进行透析且已建立AVF的患者，我们通过血气分析测量了动静脉分流处手动压迫前后的ScvO升高情况，并验证了其与DU测量的Qa之间的相关性。
我们对18例带有CVC和AVF的患者在AVF手动压迫30秒前后采集了血气样本。AVF关闭前ScvO平均为70.5±3%，关闭后为65.2±3%，平均下降5.1±3%（范围1 - 12）。通过DU在24小时内测量的AVF Qa平均为635±349 mL/min（范围50 - 1300），且与ΔScvO呈严格正相关（r = 0.954，P < 0.0001）。
因此我们建议，对于带有CVC和新建立AVF的患者，无需使用DU，仅通过测量血气和ΔScvO就可以监测AVF Qa。该技术简单、廉价、可重复、无创且不依赖操作人员，是一种新的有用的筛查测试，可检测出延迟的AVF通路成熟情况，值得及时进行DU测量和手术修复。它有助于快速识别急需DU验证和可能需要手术修复的患者。遗憾的是，它仅适用于带有CVC的患者。
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