光电容积描记法在血液透析通路相关肢端缺血征诊断的应用

doi:10.3969/j.issn.1006-298X.2018.03.004

肾脏病与透析肾移植杂志 ›› 2018, Vol. 27 ›› Issue (3): 220-224.DOI: 10.3969/j.issn.1006-298X.2018.03.004

光电容积描记法在血液透析通路相关肢端缺血征诊断的应用

出版日期:2018-06-28 发布日期:2018-06-29

Application of photoplethysmography in diagnosis of hemodialysis accessinduced distal ischemia

Online:2018-06-28 Published:2018-06-29

摘要/Abstract

摘要：

目的：探讨光电容积描记法（photoplethysmography，PPG）在血液透析通路相关肢端缺血征（hemodialysis accessinduced distal ischemia，HAIDI）诊断的应用价值。
方法：选取2016年6月至12月在北京大学第三医院海淀院区肾内科首次行动静脉内瘘术的终末期肾病患者69例，进行前瞻性队列研究。在术前（0～48h）、术后1天（12～24h）、术后1月、术后3月对所有患者双侧肢体行PPG检查，测定指标包括基础指压(basal digital pressure，BDP)、指肱指数（digital to contralateral brachial index，DBI）及压闭内瘘后指压变化（change in digital pressure with access compression，CDP）。术后1月和3月行HAIDI问卷调查，并根据患者是否出现HAIDI症状进行分组。
结果：69例患者中有62例完成随访研究，其中15例（217%）例出现HAIDI，其中5例术后3月缺血症状有所缓解。术后各时段HAIDI组BDP及DBI均明显低于非HAIDI组（P＜0001），术后1月和3月HAIDI组CDP高于非HAIDI组（P＜005）。两组患者术后各时段BDP及DBI均明显低于术前（P＜0001），HAIDI组DBI从090降至051，术后3月小幅回升至059，非HAIDI组DBI 094降至072，术后3月小幅回升至083，且HAIDI组下降幅度较非HAIDI组大。术后1月和3月HAIDI组缺血问卷调查（hand ischemic questionnaire，HIQ）评分明显高于非HAIDI组（10733±5496 vs 574±1175、10400±3924 vs 532±1018，P＜0001）。
结论：PPG可作为HAIDI诊断的工具，BDP及DBI的诊断准确性高于CDP，诊断HAIDI各指标的临界值为：BDP＜94 mmHg（灵敏度667%，特异度936%）、DBI＜06（灵敏度80%，特异度83%）、CDP＞65 mmHg（灵敏度533%，特异度915%）。

关键词: 血液透析通路相关肢端缺血征, 动静脉内瘘, 光电容积描记法

Abstract:

Ｏｂｊｅｃｔｉｖｅ：To discuss the value of the application of photoplethysmography(PPG) for the diagnosis of hemodialysis accessinduced distal ischemia(HAIDI).
Ｍｅｔｈｏｄｏｌｏｇｙ：Sixty nine patients with ESRD who were referred to our nephrology department for arteriovenous fistula creation with endtoside anastomosis between June 2016 and december 2016 were included in the prospective cohort study.Patients were asked to take PPG test in peroperative（0～48 h）,one day(12～24 h),one month and 3 months after operative,whose measurement indicators included basal digital pressure(BDP),change in digital pressure with access compression(CDP),digital to contralateral brachial index(DBI).And to respond to hand ischemia questionnaire(HIQ) in 1 and 3 month after operation.In addition,groups were divided into HAIDI or no HAIDI according to whether patients with HAIDI symptoms.
Ｒｅｓｕｌｔｓ：Sixty two patients underwent followup study,including 15 cases (217%) developed HAIDI,However,the ischemic syndrome in 5 patients had relieved 3 month after operation.BDP and DBI in HAIDI group were significantly lower than the control group in each time after operation (P<0001),CDP in HAIDI group were significantly higher than the control group in 1 and 3 month after operation.BDP and DBI in each time after operation were significantly lower than preoperation in both groups(P<001),In HAIDI group,DBI decreased from 09 to 051,and recovered slightly to 059 in 3 month after operative.However,DBI decreased from 094 to 072 in the control group,and recovered slightly to 083 in 3 month after operative.A drop of DBI in HAIDI group was significantly greater than the control group.HIQ scores in HAIDI group was significantly higher than the control group in 1 and 3 month after operative（10733±5496 vs 574±1175,and 10400±3924 vs 532±1018,P＜0001).
Ｃｏｎｃｌｕｓｉｏｎ：
PPG can be used to detect HAIDI,the diagnostic accuracy of BDP and DBI was higher than CDP,The diagnostic thresholds of HAIDI were 94 mmHg for BDP (sensitivity,667%;specificity,936%),06 for DBI (sensitivity,80%; specificity,83%),65mmHg for CDP（sensitivity,533%;specificity,915%）.

Key words: hemodialysis accessinduced distal ischemia, arteriovenous fistula, photoplethysmography

赖艳红,胡普平,杨涛,等. 光电容积描记法在血液透析通路相关肢端缺血征诊断的应用[J]. 肾脏病与透析肾移植杂志, 2018, 27(3): 220-224.

LAI Yanhong,HU Puping,YANG Tao,et al. Application of photoplethysmography in diagnosis of hemodialysis accessinduced distal ischemia[J]. Chinese Journal of Nephrology, Dialysis & Transplantation, 2018, 27(3): 220-224.

[1]	郜同心,高艳,姚志敏,等. 经皮导管溶栓联合腔内血管成型术治疗动静脉内瘘急性血栓[J]. 肾脏病与透析肾移植杂志, 2020, 29(4): 312-316.
[2]	朱一枫,李晶晶,张艺,李慧,王银,肖伟,余函,周利,黄小妹. 两种超声标准评估动静脉内瘘成熟的效能[J]. 肾脏病与透析肾移植杂志, 2020, 29(1): 26-30.
[3]	董建华，葛永纯. 自体动静脉内瘘功能障碍的机制[J]. 肾脏病与透析肾移植杂志, 2019, 28(4): 379-384.
[4]	李伟龙,胡波,黄德绪,等. 经皮腔内血管成形术治疗动静脉内瘘狭窄的疗效及影响因素[J]. 肾脏病与透析肾移植杂志, 2019, 28(3): 219-223.
[5]	董俊秀，柯栋，胡良柱，等. 两种前臂环形人工血管动静脉内瘘术式的比较[J]. 肾脏病与透析肾移植杂志, 2019, 28(3): 224-228.
[6]	谢筱彤，刘宏，涂岩，等. 维持性血液透析患者动静脉内瘘功能不良的影响因素[J]. 肾脏病与透析肾移植杂志, 2018, 27(5): 435-439.
[7]	谢筱彤,刘宏,涂岩高,等. 动静脉内瘘超声参数与内瘘功能不良的相关性研究[J]. 肾脏病与透析肾移植杂志, 2017, 26(5): 442-446.
[8]	任红旗,何群鹏,贾凤玉,等. 维持性血液透析患者血管通路使用情况分析[J]. 肾脏病与透析肾移植杂志, 2017, 26(3): 235-239.
[9]	任红旗, 刘志红. 血液透析患者动静脉内瘘与心血管系统并发症[J]. 肾脏病与透析肾移植杂志, 2016, 25(6): 563-567.
[10]	陈荣荣,俞燕, 范亚平. 动静脉内瘘血管内膜增生的细胞和分子病理机制[J]. 肾脏病与透析肾移植杂志, 2016, 25(5): 475-478.
[11]	袁丽萍\|曾海鸥\|林茴\|等. 血液透析患者人工血管移植动静脉内瘘术[J]. 肾脏病与透析肾移植杂志, 2014, 23(5): 443-446.
[12]	王蕴若\|吴昊\|王惠新\|等. 血液透析患者前臂贵要静脉转位内瘘与标准内瘘应用的比较[J]. 肾脏病与透析肾移植杂志, 2014, 23(4): 337-341.
[13]	付平，崔天蕾. 自体动静脉内瘘血栓的处理[J]. 肾脏病与透析肾移植杂志, 2013, 22(2): 139-140.
[14]	叶朝阳，戴兵. 动静脉内瘘血栓的诊断和处理[J]. 肾脏病与透析肾移植杂志, 2013, 22(2): 141-142.
[15]	徐斌. 动静脉内瘘堵塞是否首选溶栓或介入治疗[J]. 肾脏病与透析肾移植杂志, 2013, 22(2): 143-144.

ISSN 1006-298X CN 32-1425/R

光电容积描记法在血液透析通路相关肢端缺血征诊断的应用

Application of photoplethysmography in diagnosis of hemodialysis accessinduced distal ischemia

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价