Bosman P J, Boereboom F T, Eikelboom B C, Koomans H A, Blankestijn P J
Departments of Nephrology and Vascular Surgery, University Hospital Utrecht, The Netherlands.
Kidney Int. 1998 Nov;54(5):1726-30. doi: 10.1046/j.1523-1755.1998.00158.x.
The effort to reduce the incidence of graft thrombosis is mainly based on predicting venous stenosis by measuring venous drip chamber pressures. In this study we evaluated whether graft flow measurements, using an ultrasound dilution technique, would be of additional value to identify patients at risk for thrombosis.
In fifty consecutive patients with a bridge graft we measured graft flow and venous drip chamber pressure at a dialyzer blood flow of 200 ml/min. The results of these flow measurements were not used for selection of patients, nor for a diagnostic or therapeutic procedure. All thrombotic events and (radiological or surgical) interventions were registered.
A total of 17 patient-years were analyzed. In 17 patients an intervention was done, and in 18 patients thrombosis occurred. The incidence rate of thrombosis was higher in patients with a flow < 600 ml/min (N = 13) compared to patients with a flow > 600 ml/min (N = 37; rate ratio 7. 2; 95% CI, range 2.84 to 18.24, P < 0.001). In 4 patients with a flow < 600 ml/min an intervention was done within the first two months after the flow measurement. In the remaining 9 patients, 6 grafts thrombosed within this period. Five interventions were done in patients with a flow > 600 ml/min. In the remaining 32 patients only two developed spontaneous thrombosis. Remarkably, venous drip chamber pressure measurements did not discriminate between patients with graft flow > or < 600 ml/min, and showed a wide range in patients who developed spontaneous thrombosis within two months.
We suggest that graft flow measurements are helpful in selecting patients at risk for graft thrombosis.
降低移植物血栓形成发生率的努力主要基于通过测量静脉滴壶压力来预测静脉狭窄。在本研究中，我们评估了使用超声稀释技术进行移植物血流测量对于识别有血栓形成风险的患者是否具有额外价值。
在连续50例进行搭桥移植的患者中，我们在透析器血流量为200 ml/min时测量了移植物血流和静脉滴壶压力。这些血流测量结果未用于患者的选择，也未用于诊断或治疗程序。记录了所有血栓形成事件和（放射学或外科）干预措施。
共分析了17个患者年。17例患者进行了干预，18例患者发生了血栓形成。血流<600 ml/min的患者（N = 13）的血栓形成发生率高于血流>600 ml/min的患者（N = 37；率比7.2；95%CI，范围2.84至18.24，P < 0.001）。在4例血流<600 ml/min的患者中，在血流测量后的头两个月内进行了干预。在其余9例患者中，在此期间有6个移植物发生了血栓形成。血流>600 ml/min的患者进行了5次干预。在其余32例患者中，只有2例发生了自发性血栓形成。值得注意的是，静脉滴壶压力测量在移植物血流>或<600 ml/min的患者之间没有差异，并且在两个月内发生自发性血栓形成的患者中显示出广泛的范围。
我们建议移植物血流测量有助于选择有移植物血栓形成风险的患者。
