实用老年医学

实用老年医学 ›› 2021, Vol. 35 ›› Issue (1): 32-35.doi: 10.3969/j.issn.1003-9198.2021.01.009

• 临床研究 • 上一篇    下一篇

老年血液透析病人动静脉内瘘血流量对心功能及炎症反应的影响

刘家均, 廖周谊   

  1. 636400 四川省巴中市,平昌县人民医院肾内科(刘家均);
    610000 四川省成都市,四川大学华西医院肾内科(廖周谊)
  • 收稿日期:2020-06-27 发布日期:2021-01-12
  • 基金资助:
    2016年四川省卫生和计划生育科研课题(16PJ361)

Effects of arterial and venous fistula blood flow on cardiac function and inflammatory reaction in elderly patients with hemodialysis

LIU Jia-jun, LIAO Zhou-yi   

  1. LIU Jia-jun. Department of Nephrology, the People's Hospital of Pingchang, Bazhong 636400, China;
    LIAO Zhou-yi. Department of Nephrology, West China Hospital of Sichuan University, Chengdu 610000, China
  • Received:2020-06-27 Published:2021-01-12

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摘要： 目的 探讨老年血液透析病人动静脉内瘘血流量(AVFB)对心功能及炎症反应的影响。方法 选取2017年2月至2018年3月我院利用动静脉内瘘进行血液透析治疗的老年病人124例为研究对象,根据病人动静脉内瘘吻合术后1个月AVFB的流量大小,将病人分为高流量组(>600 mL/min,n=38)、中流量组(400~600 mL/min,n=45)、低流量组(<400 mL/min,n=41),并接受1年维持性血液透析治疗。于透析前后检测并比较3组病人的心功能、炎症反应、血液动力学指标,以及高危事件、内瘘失功能的发生率。结果 透析前,3组的心功能、炎症反应、血液动力学指标水平差异均无统计学意义(P>0.05)。透析后,随着AVFB的升高,病人的射血分数、心排出量、心脏指数、左室收缩末直径、左室舒张末直径、IL-6、TNF-α、CRP水平也随之升高(P<0.05),心输出量、心脏搏出量、中心血容量也随之增加(P<0.05),但外周血管阻力随着AVFB的增加而降低(P<0.05)。高流量组病人高危事件的发生率显著高于中、低流量组(P<0.05),而低流量组病人内瘘失功能的发生率明显高于高、中流量组(P<0.05)。结论 老年维持性血液透析病人的AVFB控制在400~600 mL/min时,临床效果最佳。

关键词: 维持性血液透析, 动静脉内瘘吻合术, 心功能, 炎症反应, 老年人

Abstract: Objective To explore the effect of arterial and venous fistula blood flow (AVFB) on the cardiac function and inflammatory response in the elderly patients receiving hemodialysis. Methods A total of 124 elderly patients who underwent hemodialysis with arteriovenous fistulas in our hospital from February 2017 to March 2018 were selected as the study subjects. According to the level of AVFB one month after arteriovenous fistula anastomosis, the patients were divided into high-flow group (>600 mL/min, n=38), medium-flow group (400-600 mL/min, n=45) and low-flow group (<400 mL/min, n=41). All the patients received one year maintenance hemodialysis treatment. The cardiac function, inflammatory response and hemodynamic indexes were detected, and the incidence rates of high-risk events and internal fistula dysfunction were recorded and compared among the three groups. Results Before dialysis, there were no significant differences in cardiac function, inflammatory response and hemodynamic indexes among the three groups (P>0. 05). After dialysis, with the increase of AVFB, the levels of ejection fraction, cardiac output, cardiac index, left ventricular end-systolic diameter, left ventricular end-diastolic diameter, interleukin-6, tumor necrosis factor-α, C-reactive protein, cardiac output, cardiac stroke volume and central blood volume were increased (P<0. 05), but the peripheral vascular resistance was decreased (P<0. 05). The incidence of high-risk events in the high-flow group was significantly higher than that in the low-flow group and medium-flow group (P<0. 05). The incidence rate of fistula dysfunction in the low-flow group was significantly higher than that in the high-flow group and medium-flow group (P<0. 05). Conclusions When the level of AVFB in the elderly patients receiving maintenance hemodialysis is controlled at 400-600 mL/min, the clinical effect is the best.

Key words: maintenance hemodialysis, arteriovenous fistula anastomosis, heart function, inflammation reaction, aged

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