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血液透析中动静脉内瘘的再循环

Authors
Michael Berkoben, MD
Peter J Blankestijn, MD
Section Editor
Thomas A Golper, MD
Deputy Editors
Alice M Sheridan, MD
Kathryn A Collins, MD, PhD, FACS
Translators
陈育青, 主任医师，教授

引言

血液透析通路的再循环是患者个体透析不充分的重要原因。诊断再循环对于优化透析充分性十分重要。此外，筛查再循环也可用作及早发现内瘘狭窄的监测手段，纠正内瘘狭窄可能预防血栓形成。

本专题将总结血液透析通路的再循环问题。其他原因导致的透析不充分将在别处讨论。 (参见“开具血液透析处方和评估血液透析的充分性”)

其他通过监测内瘘和人造血管来预防血栓形成的方法将在别处讨论。 (参见“成熟血液透析动静脉内瘘的临床检查与监测”和“防止血液透析动静脉移植物血栓形成的检查与监测”)

定义和机制

血液透析通路再循环是指从静脉穿刺针回流的透析后血液又再次从动脉穿刺针进入体外回路，而没有进入体内循环(图 1)。

透析过的血液再次进入体外回路后和未透析过的血液混合，从而降低了跨透析膜的溶质浓度梯度。这种混合降低了透析效率。显著的再循环可造成设定血液透析总量(设定尿素Kt/V)与实际透析总量(实际尿素Kt/V)出现差异。 (参见“Prescribed versus delivered dialysis: Importance of dialysis time”和“开具血液透析处方和评估血液透析的充分性”，关于‘实际透析剂量低的原因’一节)

       

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Literature review current through: 2017-06 . | This topic last updated: 2016-12-02.
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