Abstract：
BACKGROUND: The aim of the presented prospective observational study was to evaluate the effect of fistula flow on peripheral wave morphology and pulse wave velocity by means of the oscillometric Vicorder®-device with the purpose of fistula surveillance.
METHODS: Digitized and normalized curves of 53 haemodialysis patients at the fistula and non-fistula arm were analysed. Slope parameters and the areas under the curve of characteristic sections of pulse waves as well as the power spectrum of the pulse waves and their first and second derivatives were computed. Furthermore, the amplitude of volumetric change (AMP) was assessed. Duplex sonography served as a reference method.
RESULTS: In the comprehensive set of novel pulse wave parameters significant inter-arm differences were demonstrated and a significant delay of the systolic maximum at the fistula arm in comparison to the non-fistula arm (204 ± 3.4 vs. 162 ± 5.3 ms, p < 0.001) was proven. Unexpectedly, pulse wave velocity apparently did not differ between both arms (7.85 vs. 8.05 m/s at the fistula/non-fistula side, p = 0.942). The inter-arm differences of the slope parameters were more pronounced in forearm than in upper arm fistulas. Finally, we showed that the inter-arm difference of AMP correlated with volume flow (r = 0.326 with p = 0.017).
CONCLUSIONS: Pulse waves as assessed by oscillometric pulse wave analysis have distinct features at fistula and non-fistula arms. This is due to enhanced arteriovenous flow, i.e. in both the brachial artery and the fistula vein. The analysis of those alterations has the potential to assess fistula function.
METHODS: Digitized and normalized curves of 53 haemodialysis patients at the fistula and non-fistula arm were analysed. Slope parameters and the areas under the curve of characteristic sections of pulse waves as well as the power spectrum of the pulse waves and their first and second derivatives were computed. Furthermore, the amplitude of volumetric change (AMP) was assessed. Duplex sonography served as a reference method.
RESULTS: In the comprehensive set of novel pulse wave parameters significant inter-arm differences were demonstrated and a significant delay of the systolic maximum at the fistula arm in comparison to the non-fistula arm (204 ± 3.4 vs. 162 ± 5.3 ms, p < 0.001) was proven. Unexpectedly, pulse wave velocity apparently did not differ between both arms (7.85 vs. 8.05 m/s at the fistula/non-fistula side, p = 0.942). The inter-arm differences of the slope parameters were more pronounced in forearm than in upper arm fistulas. Finally, we showed that the inter-arm difference of AMP correlated with volume flow (r = 0.326 with p = 0.017).
CONCLUSIONS: Pulse waves as assessed by oscillometric pulse wave analysis have distinct features at fistula and non-fistula arms. This is due to enhanced arteriovenous flow, i.e. in both the brachial artery and the fistula vein. The analysis of those alterations has the potential to assess fistula function.
摘要：
所提出的前瞻性观察性研究的目的是通过示波法Vicorder®装置评估瘘管流量对周围波形态和脉搏波速度的影响，目的是进行瘘管监测。
方法：分析53例血液透析患者瘘管和非瘘管臂的数字化和标准化曲线。计算了斜率参数和脉搏波特征部分的曲线下面积以及脉搏波的功率谱及其一阶和二阶导数。此外，评估体积变化（AMP）的幅度。双重超声检查作为参考方法。
结果：在一组新的脉搏波参数中，与非瘘管臂相比，瘘管臂的收缩期最大值显着延迟（204±3.4对162±5.3ms，p<0.001)被证明。出乎意料的是,两臂之间的脉搏波速度显然没有差异（瘘管/非瘘管侧的脉搏波速度分别为7.85和8.05m/sec，p=0.942)。前臂的斜率参数的臂间差异比上臂瘘更为明显。最后,我们发现AMP的臂间差异与体积流量相关（r=0.326，p=0.017）。
结论：通过示波脉搏波分析评估的脉搏波在瘘管和非瘘管臂具有明显的特征。这是由于动静脉血流增强,即在肱动脉和瘘管静脉中。对这些改变的分析有可能评估瘘管功能。
方法：分析53例血液透析患者瘘管和非瘘管臂的数字化和标准化曲线。计算了斜率参数和脉搏波特征部分的曲线下面积以及脉搏波的功率谱及其一阶和二阶导数。此外，评估体积变化（AMP）的幅度。双重超声检查作为参考方法。
结果：在一组新的脉搏波参数中，与非瘘管臂相比，瘘管臂的收缩期最大值显着延迟（204±3.4对162±5.3ms，p<0.001)被证明。出乎意料的是,两臂之间的脉搏波速度显然没有差异（瘘管/非瘘管侧的脉搏波速度分别为7.85和8.05m/sec，p=0.942)。前臂的斜率参数的臂间差异比上臂瘘更为明显。最后,我们发现AMP的臂间差异与体积流量相关（r=0.326，p=0.017）。
结论：通过示波脉搏波分析评估的脉搏波在瘘管和非瘘管臂具有明显的特征。这是由于动静脉血流增强,即在肱动脉和瘘管静脉中。对这些改变的分析有可能评估瘘管功能。
