Kovarova Lucie, Valerianova Anna, Michna Martin, Malik Jan
Third Department of Internal Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
Department of Radiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic.
J Vasc Access. 2021 Jan;22(1):90-93. doi: 10.1177/1129729820924561. Epub 2020 Jun 3.
Decreased cerebral perfusion and oxygenation are common in hemodialysis patients. Magnitude of the arteriovenous fistula involvement in this phenomenon is not known. The aim of this study was to investigate the effect that a short-term arteriovenous fistula flow interruption has on cerebral oxygenation and to review and suggest possible explanations.
In 19 patients, basic laboratory and clinical data were obtained and arteriovenous fistula flow volume was measured by ultrasonography. Baseline regional cerebral oxygen saturation (rSO) was measured by near-infrared spectroscopy. Manual pressure was then applied on the fistula, resulting in total blood flow interruption. After 1 min of manual compression, rSO and blood pressure values were noted again. The compression-related change in rSO was assessed, as well as its association with arteriovenous fistula flow volume, blood pressure, and other parameters.
Mean cerebral rSO increased after arteriovenous fistula compression (from 53.6% ± 11.4% to 55.6% ± 10.8%; p = 0.000001; 95% confidence interval = 1.39-2.56). The rSO increase was higher in patients with lower rSO at baseline (r = -0.46; p = 0.045).
A significant rise in cerebral oxygenation was observed following the manual compression of arteriovenous fistula. Therefore, the arteriovenous fistula could have a role in impaired cerebral oxygenation in hemodialysis patients.
脑灌注和氧合减少在血液透析患者中很常见。动静脉内瘘在这一现象中的参与程度尚不清楚。本研究的目的是调查短期动静脉内瘘血流中断对脑氧合的影响，并回顾和提出可能的解释。
对19例患者，获取基础实验室和临床数据，通过超声测量动静脉内瘘血流量。采用近红外光谱法测量基线区域脑氧饱和度（rSO）。然后用手压迫内瘘，导致血流完全中断。手动压迫1分钟后，再次记录rSO和血压值。评估rSO与压迫相关的变化，以及它与动静脉内瘘血流量、血压和其他参数的关联。
动静脉内瘘压迫后脑平均rSO升高（从53.6%±11.4%升至55.6%±10.8%；p = 0.000001；95%置信区间 = 1.39 - 2.56）。基线rSO较低的患者rSO升高幅度更大（r = -0.46；p = 0.045）。
手动压迫动静脉内瘘后观察到脑氧合显著升高。因此，动静脉内瘘可能在血液透析患者脑氧合受损中起作用。
