Besarab A, Samarapungavan D
Department of Medicine (Division of Nephrology and Hypertension), Henry Ford Hospital, Detroit, MI 48202, USA.
Curr Opin Nephrol Hypertens. 1996 Nov;5(6):527-31. doi: 10.1097/00041552-199611000-00013.
Vascular access morbidity is still an important problem. The risk of thrombosis increases in prosthetic grafts as the access flow decreases below 600 ml/min, whereas native arteriovenous accesses can maintain patency at much lower flows, in some cases flows below those needed to deliver adequate dialysis. Intra-access pressures are also dissipated differently in the two access types. These differences between native and prosthetic grafts determine the utility of the monitoring techniques that are useful for detecting stenosis and assessing function in the two access types. Modern non-urea methods for measuring access recirculation are therefore useful in native but not in graft hemoaccesses. Direct or indirect intra-access pressure measurements and direct flow measurements are most useful in grafts to detect and then correct lesion before thrombosis.
血管通路并发症仍是一个重要问题。当人工血管通路血流量降至600毫升/分钟以下时，血栓形成风险增加，而自体动静脉通路在血流量低得多的情况下仍可保持通畅，在某些情况下血流量低于提供充分透析所需的水平。两种通路类型的血管内压力消散方式也有所不同。自体血管和人工血管之间的这些差异决定了监测技术在检测两种通路类型的狭窄和评估功能方面的效用。因此，现代非尿素法测量通路再循环对自体血管通路有用，但对人工血管通路无用。直接或间接测量血管内压力以及直接测量血流量对人工血管通路检测并纠正病变以防止血栓形成最为有用。
