Decrease in Access Blood Flow Predicts Significant Vascular Access Stenosis in Taiwanese Hemodialysis Patients

台灣的血液透析病人動靜脈瘻管血流量減少可預則嚴重狹窄

林信昌(Hsin-Chang Lin) ； 吳志仁(Chih-Jen Wu) ； 陳漢湘(Han-Hsiang Chen) ； 葉端圻(Jui-Chi Yeh) ； 蔡政廷(Cheng-Ting Tsai)

《Acta Nephrologica》 19卷3期 (2005/10) Pp. 104-108

摘要

血液透析病人動靜脈瘻管功能不良會造成透析效率不佳，病人罹病率及住院率上升，影響病人及家屬的生活品質，也間接造成醫療費用顯著增加。導致瘻管機能障礙最常見的原因是血栓產生因而造成痿管阻塞不通。而血栓的產生經常是因瘻管內有狹窄的病灶所引起，特別是瘻管內狹窄程度超過瘻管直徑的一半以上時，更容易造成血栓的產生。一旦瘻管產生血栓而阻塞，此時病人無可避免需要接受開刀把血栓移除，同時需接受血管擴張術，亦即PTA(Percutaneous Transluminal Angioplasty)來治療痿管內狹窄的病灶。為了減少瘻管故障對病人透析效率及生活品質產生不良的影響，我們必須在瘻管產生血栓以前，就把瘻管內的狹窄，特別是狹窄超過50%以上的病灶，儘早找出及時接受PTA治療。我們研究的目的是要評估如果瘻管內血流量小於600 mL/min或比原來下降超過25%時，是否可預測瘻管內嚴重狹窄。總共有82個固血液透析病人，每兩個月使用超音波稀釋法測量瘻管血流量，如果瘻管內血流量小於600mL/min或比原來下降超過25%，則病人將接受血管攝影檢查，若瘻管內有狹窄超過50%以上的病灶，將以PTA治療。結果在82個血液透析病人中有34人(41.5%)瘻管內血流量小於600mL/min或比原來下降超過25%，這34病人經血管攝影檢查發現所有的病人(100%)瘻管內都有一個或多個狹窄超過50%以上的病灶。大部分的病人(61.8%)瘻管有兩個或兩個以上狹窄超過50%以上的病灶，平均瘻管內狹窄比例70.4%(50-95%)，經血管擴張術治療後，瘻管內狹窄比例降至17.5%(5-50%)，平均瘻管內血流量為349(130-590)mL/min，以血管擴張術治療後，平均瘻管內血流量上升至868(460-1560) mL/min。結論是國外文獻提到如果瘻管內血流量小於600mL/min或比原來下降超過25%可預測瘻管有超過50%以上的嚴重狹窄病灶，對於我們台灣的血液透析病人也同樣適用。

關鍵字

動靜脈瘻管血流量 ； 血液透析 ； 瘻管內狹窄 ； 血管擴張術

並列摘要

Vascular access (VA) thrombosis represents a leading cause of morbidity in chronic hemodialysis (CHD) population. Unanticipated thrombosis generally results in surgical or radiological intervention for the removal of the thrombus and repair of the attendant stenotic lesion. VA stenosis account for the most important reason why thrombosis occur, especially in a significant stenosis with greater than 50% of diameter of VA lumen. Progressive stenosis of VA gradually reduce blood flow. We evaluated the accuracy of clinical criteria of vascular access blood flow (VABF)＜600 mL/min or decreased＞25% in predicting significant stenosis of VA. Eighty two VA in 82 CHD patients were followed over 12 months. VABF was measured by ultrasound dilution technique every 2 months. Patients with VABF less than 600 mL/min or decrease by 25% will be referred to fistulography. Percutaneous transluminal angioplasty (PTA) would be performed for a significant stenotic lesion. Thirty-four VA (41.5%) were found to meet the criteria of abnormal VABF, 26 access (76.5%) with VABF less than 600 mL/min, 8 access (23.5%) with VABF decreased by 25%. Most of the patients(61.8%) with VA stenosis undergoing fistulography had multiple stenotic lesions. The other 13 patients (38.2%) had single stenotic lesion. The mean percentage of VA stenosis was 70.4% (50-95%).
Following PTA, it had been reduced to 17.5% (5-50%). The most common site of VA stenosis is the vein near anastomosis. A decrease in VABF (less than 600 mL/min or by 25%) appears to have a greater accuracy in predicting significant vascular access stenosis and the abnormal VABF criteria suggested in the literatures was suitable for Taiwanese CHD patients.

並列關鍵字

Vascular access blood flow ； stenosis ； Percutaneous transluminal angioplasty ； Hemodialysis