■血管通路,包括动静脉瘘(AVF),在接受血液透析(HD)的患者中至关重要。然而,AVF的存在在人类是非生理性的,可能对体循环或组织微循环造成负担,可能影响组织氧合,包括在大脑中。最近,近红外光谱已用于测量区域氧饱和度(rSO2),作为各种环境中脑氧合的标志,包括接受HD的患者。到目前为止,没有研究报道AVF产生前后脑rSO2的变化.本研究旨在监测AVF产生前后脑氧合的差异,并阐明影响脑rSO2变化的临床因素。
■48名患者(34名男性,招募了14名患有慢性肾脏疾病(CKD)且未接受透析和新创建的AVF的女性。使用近红外光谱(INVOS5100c)评估AVF产生前后的脑rSO2值。
■所有患者在AVF产生前后,脑rSO2值从60.3%±7.5%显著变化为58.4%±6.8%(p<0.001)。术前糖尿病(DM)患者的脑rSO2也低于无DM患者(57.5±7.1vs63.7±6.5,p=0.003);然而,建立AVF后,两组之间的脑rSO2变化无差异。此外,多元回归分析将HR的变化(标准化系数:0.436)确定为与脑rSO2变化相关的独立因素。
■手术产生的AVF与未接受透析的CKD患者的脑rSO2恶化有关。值得注意的是,AVF会导致脑缺氧,因此需要进一步的研究来阐明影响AVF后脑氧合变化的临床因素.
UNASSIGNED: Vascular access, including arteriovenous fistula (AVF), is essential in patients undergoing hemodialysis (HD). However, the presence of AVF is non-physiological in humans and could pose a burden to the systemic circulation or tissue microcirculation, potentially affecting tissue oxygenation, including in the brain. Recently, near-infrared spectroscopy has been used to measure regional oxygen saturation (rSO2) as a marker of cerebral oxygenation in various settings, including in patients undergoing HD. Thus far, no studies have reported changes in cerebral rSO2 before and after AVF creation. This study aimed to monitor the differences in cerebral oxygenation before and after AVF creation and to clarify the clinical factors affecting the changes in cerebral rSO2.
UNASSIGNED: Forty-eight patients (34 men, 14 women) with chronic kidney disease (CKD) who were not undergoing dialysis and newly created AVF were recruited. Cerebral rSO2 values before and after AVF creation were evaluated using near-infrared spectroscopy (INVOS 5100c).
UNASSIGNED: Cerebral rSO2 values were significantly changed from 60.3% ± 7.5% to 58.4% ± 6.8% before and after AVF creation in all patients (p < 0.001). Cerebral rSO2 were also lower in patients with diabetes mellitus (DM) than in those without DM (57.5 ± 7.1 vs 63.7 ± 6.5, p = 0.003) before surgery; however, no differences of changes in cerebral rSO2 were observed between the two groups after AVF creation. Additionally, multivariate regression analysis identified changes in HR (standardized coefficient: 0.436) as independent factors associated with changes in cerebral rSO2.
UNASSIGNED: Surgically created AVF was associated with the deterioration of cerebral rSO2 in patients with CKD not undergoing dialysis. Notably, AVF could cause cerebral hypoxia, and thus further studies are needed to clarify the clinical factors influencing changes in cerebral oxygenation after AVF creation.