光电容积描记法在血液透析通路相关肢端缺血征诊断的应用  

Application of photoplethysmography in diagnosis of hemodialysis access-induced distal ischemia

作　　者：赖艳红[1] 胡普平[1] 杨涛[1] 刘音[1] 刘静 王玉柱[1] LA;HU Puping;YANG Tao;LIU Yin;LIU Jing;WANG Yuzhu(Department of Nephrology, Beijing Haidian Hospital, Beijing Haidian Section of Peking University Third Hospital, Beijing 100080, China)

机构地区：[1]北京市海淀医院北京大学第三医院海淀院区肾内科,北京100080

出　　处：《肾脏病与透析肾移植杂志》2018年第3期220-224,228,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

摘　　要：目的:探讨光电容积描记法(photoplethysmography,PPG)在血液透析通路相关肢端缺血征(hemodialysis access-induced distal ischemia,HAIDI)诊断的应用价值。方法:选取2016年6月至12月在北京大学第三医院海淀院区肾内科首次行动静脉内瘘术的终末期肾病患者69例,进行前瞻性队列研究。在术前(0～48h)、术后1天(12～24h)、术后1月、术后3月对所有患者双侧肢体行PPG检查,测定指标包括基础指压(basal digital pressure,BDP)、指肱指数(digital to contralateral brachial index,DBI)及压闭内瘘后指压变化(change in digital pressure with access compression,CDP)。术后1月和3月行HAIDI问卷调查,并根据患者是否出现HAIDI症状进行分组。结果:69例患者中有62例完成随访研究,其中15例(21.7%)例出现HAIDI,其中5例术后3月缺血症状有所缓解。术后各时段HAIDI组BDP及DBI均明显低于非HAIDI组(P<0.001),术后1月和3月HAIDI组CDP高于非HAIDI组(P<0.05)。两组患者术后各时段BDP及DBI均明显低于术前(P<0.001),HAIDI组DBI从0.90降至0.51,术后3月小幅回升至0.59,非HAIDI组DBI 0.94降至0.72,术后3月小幅回升至0.83,且HAIDI组下降幅度较非HAIDI组大。术后1月和3月HAIDI组缺血问卷调查(hand ischemic questionnaire,HIQ)评分明显高于非HAIDI组(107.33±54.96 vs 5.74±11.75、104.00±39.24 vs 5.32±10.18,P<0.001)。结论:PPG可作为HAIDI诊断的工具,BDP及DBI的诊断准确性高于CDP,诊断HAIDI各指标的临界值为:BDP<94 mmHg(灵敏度66.7%,特异度93.6%)、DBI<0.6(灵敏度80%,特异度83%)、CDP>65 mmHg(灵敏度53.3%,特异度91.5%)。Objective：To discuss the value of the application of photoplethysmography（ PPG） for the diagnosis of hemodialysis access-induced distal ischemia（ HAIDI）. Methodology：Sixty nine patients with ESRD who were referred to our nephrology department for arteriovenous fistula creation with end-to-side anastomosis between June 2016 and december2016 were included in the prospective cohort study.Patients were asked to take PPG test in peroperative（ 0 ～ 48 h）,one day（12～24 h）,one month and 3 months after operative,whose measurement indicators included basal digital pressure（BDP）,change in digital pressure with access compression（ CDP）,digital to contralateral brachial index（ DBI）. And to respond to hand ischemia questionnaire（ HIQ） in 1 and 3 month after operation. In addition,groups were divided into HAIDI or no HAIDI according to whether patients with HAIDI symptoms. Results： Sixty two patients underwent follow-up study,including 15 cases（ 21. 7%） developed HAIDI,However,the ischemic syndrome in 5 patients had relieved 3 month after operation.BDP and DBI in HAIDI group were significantly lower than the control group in each time after operation（ P〈0. 001）,CDP in HAIDI group were significantly higher than the control group in 1 and 3 month after operation. BDP and DBI in each time after operation were significantly lower than preoperation in both groups（ P〈0. 01）,In HAIDI group,DBI decreased from 0. 9 to 0. 51,and recovered slightly to 0. 59 in 3 month after operative.However,DBI decreased from 0. 94 to0. 72 in the control group,and recovered slightly to 0. 83 in 3 month after operative. A drop of DBI in HAIDI group was significantly greater than the control group.HIQ scores in HAIDI group was significantly higher than the control group in 1 and 3 month after operative（ 107. 33 ± 54. 96 vs 5. 74 ± 11. 75,and 104. 00 ± 39. 24 vs 5. 32± 10. 18,P〈0. 001）.Conclusion：PPG can be used to detect HAIDI,the diagnostic accuracy of BDP and DBI was higher than CDP,The

关 键 词：血液透析通路相关肢端缺血征 动静脉内瘘 光电容积描记法 

分 类 号：R692.5[医药卫生—泌尿科学]