【摘要】目的探讨不同透析血流量对血液透析患者内瘘并发症的影响。方法选择2019 年1 月至2019 年3 月在温州医科大学附属第二医院首次进行自体动静脉内瘘(autologous arteriovenous fistula, AVF)手术的患者40 例和采用AVF 进行常规血液透析的患者40 例。新AVF 患者随机分为观察组和对照组(n=20)，观察组初始透析血流量160～200 ml/min，1 个月后220～250 ml/min；对照组初始透析血流量220～250 ml/min，1 个月后280～310 ml/min。成熟AVF 患者随机分为观察组和对照组(n=20)，观察组透析血流量220～250 ml/min；对照组透析血流量280～310 ml/min。患者每周透析3 次，持续透析12个月。观察各组内瘘失功率和并发症发生情况，检测相关生化指标，并对透析充分性进行评估。结果观察组内瘘失功率和并发症发生率均明显减少，其中新AVF 观察组并发症发生率与对照组比较差异具有统计学意义(χ2=6.465,P=0.011)；成熟AVF 患者观察组内瘘失功率(χ2=3.135,P=0.077)和并发症发生率
(χ2=3.135,P=0.077)与对照组相比均无显著差异。新AVF 和成熟AVF 患者观察组的透析充分率分别较对照组下降，但Fisher 精确检验分析无显著差异(P 分别为0.451,0.407)。结论降低血流量能显著减少AVF患者内瘘并发症的发生，改善AVF 患者内瘘预后，且对患者的透析充分性无显著影响。
【Abstract】Objective To explore the effect of different dialysis blood flow on complications of internal fistula in hemodialysis patients. Methods Forty patients undergoing autologous arteriovenous fistula (AVF) surgery for the first time and 40 patients using AVF for routine hemodialysis in The Second Affiliated Hospital of Wenzhou Medical University from January to March 2019 were enrolled in this study. Patients with new AVFs were randomly divided into model group (n=20) and control group (n=20). In model group, the dialysis blood flow was 160～200 ml/min at the beginning and increased to 220-250 ml/min after one month. In control
group, the dialysis blood flow was initially 220～250 ml/min and increased to 280～310 ml/min after one month. Patients with mature AVFs were also randomly divided into model group (n=20) and control group (n=20). The dialysis blood flow was 220～250 ml/min in model group and was 280～310 ml/min in control group. All patients were dialyzed 3 times a week for 12 months. Dysfunction and complications of the AVFs were observed, related biochemical indicators were assayed, and dialysis sufficiency was evaluated in these groups. Results Dysfunction and complications of the AVFs were significantly reduced in the two model
groups. In patients with new AVFs, the rate of AVF complications was significantly lower in model group than in control group (χ2=6.465, P=0.011). In patients with mature AVFs, the rates of AVF dysfunction (χ2=3.135, P=0.077) and AVF complications (χ2=3.135, P=0.077) had no differences between model group and control group. In patients with new AVFs and with mature AVFs, dialysis sufficiency was lower in model groups than in their respective control groups, but without statistical significance (Fisher exact analyses, P=0.451 and 0.407). Conclusion Reduction of dialysis blood flow can decrease the presence of AVF complications and improve the prognosis of AVF, without significant impact on dialysis sufficiency.
[1]王笑云.要重视透析血管通路创建维护和并发症的防治[J].中国血液净化, 2007, 006(007):349-351
[2]Arnold WP.Improvement in Hemodialysis Vascular Access Outcomes in a Dedicated Access Center[J].Seminars in Dialysis, 2000, 13(6):359-363
[3] K S, H J, M W.Effect of Early Cannulation with Plastic Cannula on Arteriovenous Fistula Patency in Hemodialysis Patients [J]. [J].Blood Purif, 2020, 49:79-84
[4] 高永财, 李博, 陆晓华, et al.血液透析患者自体动静脉内瘘失功的相关因素分析 [J]. 宁夏医学杂志, 40(3): 246-248.
[5]Asano M, Thumma J, Oguchi K, et al.Vascular Access Care and Treatment Practices Associated with Outcomes of Arteriovenous Fistula: International Comparisons from the Dialysis Outcomes and Practice Patterns Study[J].Nephron Clinical Practice, 2013, 124(1-2):23-30
[6] 伍刚, 王荣, 刘佳玮, et al.日本最新(2015)血液透析血管通路指南解读 [J]. 中国血液净化, 016(8): 551-554.
[7] Mikito N, Naoki I, Shingo T, et al.AST-120 ameliorates lowered exercise capacity and mitochondrial biogenesis in the skeletal muscle from mice with chronic kidney disease via reducing oxidative stress [J]. Nephrology Dialysis Transplantation, 2015, 6): 6.
[8]Guijarro C, Egido J.Transcription factor-kappa B (NF-kappa B) and renal disease[J].Kidney Int, 2001, 59(2):415-
[9] RP A, JF C, VO G, et al.Effects of uremic solutes on reactive oxygen species in vitro model systems as a possibility of support the renal function management [J]. BMC Nephrol, 2015, 16(50.
[10] Dixon, S B.Why don\" t fistulas mature? [J]. Kidney Int, 70(8): 1413-1422.
[11]Ravani P, Spergel LM, Asif A, et al.Clinical epidemiology of arteriovenous fistula in 2007[J].Journal of Nephrology, 2007, 20(2):141-149
[12] Wootton DM, Ku DN.Fluid Mechanics of Vascular Systems, Diseases, and Thrombosis [J]. Annu Rev Biomed Eng, 1(1): 299-329.
[13]P M, RL W, Y S, et al.Vascular access blood flow monitoring reduces access morbidity and costs[J].Kidney Int, 2001, 60(3):1164-1172
