Lopot František, Malík Jan, Švára František, Polakovič Vladimír
General University Hospital, Department of Medicine, Prague - Strahov, Czech Republic.
First Medical Faculty, Charles University, Institute of biophysics, Prague, Czech Republic.
J Vasc Access. 2021 Jul;22(4):575-584. doi: 10.1177/1129729820953021. Epub 2020 Sep 1.
Records of 10,000 QVA measurement performed in 549 patients over 20 years were used as retrospective and anonymized data source, making ethical commission involvement unnecessary. Two approaches are used to elucidate association of QVA changes with different factors: analyses of smaller cohorts in which both the QVA and the respective factor were measured (e.g. association of QVA with cardiac output (CO)), or-in case of rare phenomena-a form of a well illustrated case reports was used (e.g. association of QVA and Kt/V).
Significant increase in CO after permanent VA creation (3-4-fold of the QVA value) was found. Impact of intradialytic CO changes on QVA is attenuated by relatively stable VA resistance compared to systemic resistance. Blood pressure impact is much stronger and it should therefore be noted at each QVA measurement. As reproducibility of different QVA measurement methods varies, use of the same method should be preferred. Direction of the arterial needle insertion in VA affects the QVA measured, especially in synthetic grafts, too. Also patient's own QVA variability may be quite high. All this makes KDOQI/EBPG recommended acceptable QVA drops too strict, they should be revised. In re-stenoses prone patients, measurement intervals should be shortened, too.
QVA values are significantly affected by many factors. Their knowledge appears essential for safe and effective VA surveillance and management.
将20年间549例患者进行的10,000次QVA测量记录用作回顾性匿名数据源，无需伦理委员会参与。采用两种方法阐明QVA变化与不同因素的关联：分析同时测量了QVA和相应因素的较小队列（例如QVA与心输出量（CO）的关联），或者在罕见现象的情况下，采用一种有充分说明的病例报告形式（例如QVA与Kt/V的关联）。
发现永久性VA建立后CO显著增加（为QVA值的3至4倍）。与全身阻力相比，透析中CO变化对QVA的影响因VA阻力相对稳定而减弱。血压影响要强得多，因此在每次QVA测量时都应予以注意。由于不同QVA测量方法的可重复性不同，应优先使用相同的方法。VA中动脉穿刺针的插入方向也会影响所测量的QVA，尤其是在人工血管中。此外，患者自身的QVA变异性可能也相当高。所有这些使得KDOQI/EBPG推荐的可接受QVA下降过于严格，应予以修订。在易发生再狭窄的患者中，测量间隔也应缩短。
QVA值受多种因素显著影响。了解这些因素对于安全有效地监测和管理VA似乎至关重要。
