Sands J, Glidden D, Miranda C
Renal Consultants of Wyoming Valley, P.C., Wilkes-Barre, Pennsylvania, USA.
ASAIO J. 1996 Sep-Oct;42(5):M530-2. doi: 10.1097/00002480-199609000-00042.
Hemodialysis accesses must supply adequate blood flow to perform hemodialysis and maintain access patency. Access flow (QA) is not measured routinely during hemodialysis. The purpose of this study was to evaluate whether access flow changes during hemodialysis and to determine which factors correlate with QA. The authors measured hemodialysis access flow by ultrasound dilution (QA-T) (Transonic HD01 hemodialysis monitor; Transonic Systems, Inc., Ithaca, NY) and duplex ultrasound, with time-domain correlation (QA-S) (Philips CVI Phillips Medical Systems, Santa Ana, CA) hourly, in 19 patients during hemodialysis. Mean arterial pressure (MAP) (Fresenius automated blood pressure cuff) and cardiac output (CO) (Transonic hemodialysis monitor; Transonic Systems, Inc.) also were measured sequentially. Using duplex ultrasound, access flow was unchanged. However, it fell 132 +/- 137 ml/m (p < 0.05) by ultrasound dilution in hr 4. Cardiac output fell 586 +/- 840 ml/ m (p < 0.05), and MAP fell 11.9 +/- 13.0 mmHg (p < 0.01). There were small positive correlations between CO and QA (correlation coefficient (r) = 0.32, QA-T; r = 0.27, QA-S; p < 0.05), and between CO and MAP (r = 0.35; p < 0.01). In conclusion, access flow, CO, and MAP decreased modestly during hemodialysis. Further studies are necessary to see if access flow is similar off dialysis, and whether in-line access flow measurements can decrease access thrombosis.
血液透析通路必须提供足够的血流量以进行血液透析并维持通路通畅。在血液透析过程中，通常不会常规测量通路血流量（QA）。本研究的目的是评估血液透析过程中通路血流量是否发生变化，并确定哪些因素与QA相关。作者在19例患者进行血液透析期间，每小时使用超声稀释法（QA-T）（Transonic HD01血液透析监测仪；Transonic Systems公司，纽约州伊萨卡）和具有时域相关性的双功超声（QA-S）（飞利浦CVI飞利浦医疗系统公司，加利福尼亚州圣安娜）测量血液透析通路血流量。还依次测量了平均动脉压（MAP）（费森尤斯自动血压袖带）和心输出量（CO）（Transonic血液透析监测仪；Transonic Systems公司）。使用双功超声检查，通路血流量没有变化。然而，在第4小时通过超声稀释法测得通路血流量下降了132±137 ml/m（p<0.05）。心输出量下降了586±840 ml/m（p<0.05），平均动脉压下降了11.9±13.0 mmHg（p<0.01）。CO与QA之间存在小的正相关性（相关系数（r）=0.32，QA-T；r=0.27，QA-S；p<0.05），CO与MAP之间也存在正相关性（r=0.35；p<0.01）。总之，在血液透析过程中，通路血流量、CO和MAP均有适度下降。有必要进一步研究透析外的通路血流量是否相似，以及在线通路血流量测量是否可以减少通路血栓形成。
