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 that ①Qa 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); and ⑤the 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.
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