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目的观察血液透析患者低位自体动静脉内瘘(AVF)瘘口直径对心功能和血压的影响。方法将70例接受前臂低位AVF手术的血液透析患者根据术后超声所测得的内瘘口直径(AVFD)分为3组,A组(n=18例)直径2.0~2.9 mm;B组(n=29例)直径3.0~3.9 mm;C组(n=23例)直径4.0~4.9 mm。每组患者手术前、后行彩色多普勒超声检查,记录心率(HR)、心排出量(CO)、心脏指数(CI)、左室射血分数(EF)、动静脉内瘘口血流量(AVFB),分析3组不同AVFD对血液透析患者心功能的影响及相关性。结果 3组患者AVF术后CO、CI值较术前明显增高(P<0.05),而EF值手术前后比较无显著性差异(P>0.05)。3组患者AVFB、△CO(CO差值)、△CI(CI差值)均随AVFD增大而递增,且组间比较存在显著性差异(P<0.05);且△CO、△CI与AVFD、AVFB呈直线正相关(r=0.514,P<0.05)。结论血液透析患者心功能的变化与AVF瘘口直径大小密切相关,合适的内瘘口直径对于减小AVF对心功能的影响,并保障血透患者血管通路长期通畅至关重要。
Objective To investigate the effects of low-level AVF fistula diameter on cardiac function and blood pressure in hemodialysis patients. Methods Seventy patients with hemodialysis undergoing low-level forearm AVF surgery were divided into three groups according to the diameter of fistula (AVFD) measured by postoperative ultrasound. Group A (n = 18) was 2.0 to 2.9 mm in diameter. Group B ( n = 29 cases) diameter 3.0 ~ 3.9 mm; group C (n = 23 cases) diameter 4.0 ~ 4.9 mm. Color Doppler echocardiography was performed before and after operation in each group. The heart rate (HR), cardiac output (CO), cardiac index (CI), left ventricular ejection fraction (EF), arteriovenous fistula blood flow (AVFB) to analyze the influence of three groups of different AVFD on cardiac function in hemodialysis patients and their correlation. Results The CO and CI values of AVF group were significantly higher than those before the operation (P <0.05). There was no significant difference between the two groups before and after AVF operation (P> 0.05). AVFB, △ CO (CO difference) and △ CI (CI difference) increased with the increase of AVFD in three groups, and there was significant difference between the two groups (P <0.05); and △ CO, △ CI and AVFD , AVFB showed a positive linear correlation (r = 0.514, P <0.05). Conclusion The change of cardiac function in hemodialysis patients is closely related to the diameter of AVF fistula. Appropriate fistula diameter is important to reduce the influence of AVF on cardiac function and to ensure long-term vascular access in hemodialysis patients.