【摘要】目的观察使用自体动静脉内瘘(arteriovenous fistula,AVF)进行维持性血液透析(maintenance hemodialysis,MHD)患者的内瘘血流量(Qa)、心输出量(CO)和平均动脉压(MAP)的变化。方法 选取使用自体动静脉内瘘进行MHD 的患者54 例。采用超声稀释法观察血液透析开始后30min、120min 和180min3 个时间点Qa、CO 和MAP 的变化，观察Qa 的变化趋势及CO 和MAP 在不同时间点对Qa 的影响。结果一次血液透析过程中3 个时间点检测的患者动静脉内瘘血流量，以及各时间点心输出量、平均动脉压无明显波动，变化均无显著性差异(P＞0.05)。透析过程中患者的动静脉内瘘Qa 与即刻CO 及MAP 均成正相关(P＜0.05)。透析30min 至透析180min 之间Qa 变化的百分比(△Qa1-3%)与CO 变化的百分比(△CO1-3%) (r=0367，P =0.009)，与MAP 变化的百分比(△MAP1-3%)(r=0.455,P=0.001)均存在正相关性。超滤量大于干体质量5%的患者Qa 的变化及CO 的变化显著大于超滤量小于干体质量5%的患者。(P＜0.05)。结论 MHD 患者在血液透析过程各个时间段的动静脉内瘘血流量、心输出量、平均动脉压基本稳定并呈正相关，随着超滤脱水量的增加会影响内瘘血流量及心输出量的明显变化，进而影响血流动力学的稳定性。

【Abstract】Objective To observe the relationship between blood access from arteriovenous fistula (Qa) and the changes of cardiac output (CO) and mean arterial pressure (MAP) in maintenance hemodialysis (MHD) patients. Method A total of 54 MHD patients with arteriovenous fistula (AVF) were enrolled in this
study. Variations of Qa by ultrasound dilution technique, CO, and MAP were observed at 30 minutes, 2 hours, and 3 hours after starting a hemodialysis session to study Qa affected by the changes of CO and MAP in a hemodialysis session. Result Qa, CO and MAP changed insignificantly at the 3 time points in a hemodialysis session (P>0.05). Qa was positively correlated with CO and MAP at the same time point (P<0.05)., The percentage of Qa variation within the 3 time points (△Qa1-3%) was positively correlated with the percentage of CO variation (△CO1-3%) (r=0367, P=0.009), and the percentage of MAP variation (△MAP1-3%) (r=0.455, P=0.001). The variation of Qa and CO were significantly greater in patients having ultrafiltration volume of > 5% dry body weight than in those having ultrafiltration volume of <5% dry body weight (P＜0.05). Conclusion Qa, CO and MAP were relatively stable in a hemodialysis session. Qa was positively correlated with CO and MAP. The increase of ultrafiltration volume in a session may result in the changes of Qa and CO and thus interfere with the stability of hemodynamics.