Butterly D W, Schwab S J
Department of Medicine, Duke University Medical Center, Durham, N.C 27710, USA.
Am J Nephrol. 1996;16(1):45-51. doi: 10.1159/000168969.
The effective delivery of dialysis requires repeated reliable access to the central circulation capable of providing rapid blood flow. This access to the circulation continues to be the 'weak link' in the provision of long-term renal replacement therapy. Dialysis access malfunction is a major cause of inadequate dialysis delivery and venous stenosis is the leading cause of access malfunction and thrombosis. Careful monitoring of venous dialysis pressures and recirculation along with urea kinetic modeling and physical examination of the graft can prospectively identify the malfunctioning vascular access. When these indicators are used for referral for fistulogram, venous stenosis can be identified and corrected before graft thrombosis. Not only can preemptive repair of the vascular access prevent thrombosis, it also allows for more efficient dialysis delivery to the patient.
有效的透析治疗需要反复可靠地接入能够提供快速血流的中心循环系统。这种接入循环系统的方式仍然是长期肾脏替代治疗中的“薄弱环节”。透析通路故障是透析治疗不充分的主要原因，而静脉狭窄是通路故障和血栓形成的主要原因。仔细监测静脉透析压力和再循环，同时结合尿素动力学建模和对移植物的体格检查，可以前瞻性地识别出功能不良的血管通路。当这些指标用于转诊进行动静脉内瘘造影时，可以在移植物血栓形成之前识别并纠正静脉狭窄。对血管通路进行预防性修复不仅可以预防血栓形成，还能使患者获得更有效的透析治疗。
