血液透析过程中血压和泵控血流量与内瘘流量关系的研究  

Study on the relationship between the blood pressure and pumped blood flow rate and the blood flow rate in fistula during hemodialysis

作　　者：赵培楠 阮琳 李文 徐元恺[2] 牛哲莉[1] 杨艳丽 张丽红[1] ZHAO Pei-nan;RUAN Lin;LI Wen;XU Yuan-kai;NIU Zhe-li;YANG Yan-li;ZHANG Li-hong(Department of Nephrology II,The First Hospital of Hebei Medical University,Shijiazhuang 050000,China;Department of Nephrology,Zhejiang Hospital,Hangzhou 310030,China)

机构地区：[1]河北医科大学第一医院肾内二科,石家庄050000 [2]浙江医院肾内科,杭州310030

出　　处：《中国血液净化》2023年第8期629-632,共4页Chinese Journal of Blood Purification

基　　金：河北省卫生健康创新专项(21377747D)。

摘　　要：目的探索血液透析过程中血压和泵控血流量与内瘘流量(access flow,Qa)的关系。方法采用电子血压计和掌上超声分别测量透析前、透析开始后30分钟内泵控血流量分别为200、250、300 ml/min时的血压和Qa以及在透析2小时及4小时(下机前20分钟内)的血压和Qa。结果共纳入104例维持性血液透析患者。研究发现:①第一阶段(0~2h)、第二阶段(2~4h)Qa和平均动脉压(mean arterial pressure,MAP)变化率呈正相关(r=0.447、0.355,均P<0.001)。②透析前、透析2小时和透析4小时的MAP和Qa差异具有统计学意义(F=77.068、32.887,均P<0.001)。③透析4小时的MAP和Qa分别比透析前降低了14.593 mmHg(95%CI:11.613~17.572,P<0.001)、105.853 ml/min(95%CI:72.757~138.948,P<0.001)。④对Qa变化率(y)与MAP变化率(x)进行线性拟合得出:y=0.75x,P<0.001。⑤Qa与泵控血流量的升高差异无统计学意义(F=2.352,P=0.099)。结论在透析过程中,Qa随MAP下降而下降,MAP每降低10%,Qa将降低7.5%。Qa与泵控血流量无关。Objective To explore the relationship between the blood pressure and pumped blood flow rate and the blood flow rate in fistula(access flow,Qa)during hemodialysis sessions.Method The electronic sphygmomanometer and hand-held Doppler ultrasound apparatus were used to measure blood pressure and Qa before hemodialysis,within 30 minutes of the hemodialysis session at blood flow rate of 200 ml/min,250 ml/min and 300 ml/min,at the 2nd hour and 4th hour(within 20 minutes before end of the sessions)of the hemodialysis session.Result A total of 104 maintenance hemodialysis patients were enrolled in this study.We found that①Qa and the change rate of mean arterial pressure(MAP)were positively correlated both at the first stage of hemodialysis(0~2nd hours;r=0.447,P<0.001)and the second stage of hemodialysis(2nd~4th hours;r=0.355,P<0.001);②MAP and Qa were statistically different between the values before dialysis,at the 2nd hour of dialysis,and at the 4th hour of dialysis(F=77.068 and 32.887,P<0.001);③MAP decreased by 14.593 mmHg(95%CI 11.613~17.572,P<0.001)and Qa decreased by 105.853 ml/min(95%CI 72.757~138.948,P<0.001)at the 4th hour of dialysis,as compared those before dialysis;④the linear fitting between Qa change rate(y)and MAP change rate(x)derived an equation of y=0.75x(P=0.000);and⑤the difference between Qa and increased pumped blood flow rate had no statistical significance(F=2.352,P=0.099).Conclusions During hemodialysis sessions,Qa decreases along with the decrease of MAP;when MAP decreases by 10%,Qa will decrease by 7.5%.Qa is unrelated to the pumped blood flow rate.

关 键 词：血液透析 多普勒超声 平均动脉压 内瘘流量 

分 类 号：R459.5[医药卫生—治疗学]