Autologous Arteriovenous Fistula To Establish The Initial Serum ET-1, NO Clinical Research

Background and ObjectiveHemodialysis is the end-stage renal disease (ESRD) patients an effective alternative treatment methods, good hemodialysis vascular access is to ensure the smooth progress of the key, autologous arteriovenous fistula (autologous arteriovenous fistula, AVF) the need for long-term hemodialysis patient is the best choice. Autogenous arteriovenous fistula maturation refers fistula puncture extravasation minimal risk, the entire process can provide sufficient blood flow. At present, for autogenous arteriovenous fistula maturation no uniform standard. K/DOQI guidelines that fistula use for at least1month after surgery, preferably6-8weeks later; fistula maturation should follow the three "6" principle, namely fistula blood flow>600ml/min, arterial venous vessel diameter>0.6cm, subcutaneous depth <0.6cm, vascular boundaries clearly visible [1]. However, this is no conclusive evidence to support the view of the provisions of the Working Group for the ideal fistula maturation standards have not been agreed upon. Multiple articles AVF color Doppler ultrasound blood flow inside diameter and found an increase in blood flow, including fistula often occurs just after1-4weeks to establish that in a month later stabilized flow and diameter, are no longer changed significantly, so simply to vessel diameter, blood flow as a mature judgment criteria may seem inadequate. This issue through the initial action within four weeks in patients with arteriovenous fistula serum endothelin-1and nitric oxide concentration monitor, evaluate endothelial injury and repair, and comparing color Doppler ultrasound, attempts to explore the autogenous arteriovenous fistula early establishment of systemic hemodynamic changes and the best puncture stress time.Materials and Method:The object of study from our hospital blood purification center for patients with end-stage renal disease selected33cases were followed up, the patient required renal replacement therapy and the first long-term path for the autogenous arteriovenous fistula, while excluding malignancy, autoimmune disease, myasthenia infection or acute phase of infection, congenital heart disease, valvular heart disease, severe arrhythmia, heart disease, exhaustion, and life expectancy is less than6months, severe anemia (HGB<60g/1), blood diseases. All of the subjects were on the day of surgery, postoperative one week, two weeks, three weeks, four weeks early morning fasting blood samples, in part immediately sent to routine laboratory blood glucose (Glu), lipids, renal function, albumin, blood, calcium and phosphorus. Another part of the Elisa method using serum endothelin-1and nitric oxide concentrations, and general condition of the patient record. While in surgery within4weeks after the first few minutes five times using two-dimensional color Doppler examination clearly show+anastomotic arterial and venous side of its main vessels, measuring its diameter, anastomotic diameter by ultrasound built-in software automatically calculates blood flow. Record peak blood flow. Application of SPSS17.0statistical package for statistical analysis of all data, P<0.05was considered statistically significant.Results:(1) The day of surgery patients, postoperative one week, two weeks, three weeks, four weeks systolic blood pressure, diastolic blood pressure, blood glucose (Glu), lipids, renal function, albumin, blood, calcium and phosphorus levels were no significant differences in the level (P>0.05).(2) Patients after one week compared with the day of surgery, ET-I, NO decreased significantly (P<0.05)(3) Patients after two weeks and one week after surgery compared, ET-I, NO significantly increased, but the level is below the day of surgery (P<0.05)(4) Patients after three weeks and two weeks after comparison, ET-I, NO increased (P<0.05)(5) After three weeks to patients with ET-1, NO levels tend to stable, no significant change after the fourth week, unchanged compared with the day of surgery (P>0.05)(6) Patients begin radial artery, cephalic vein trunk vessel diameter increases blood flow to three weeks after surgery trend in gently.Conclusion:(1) Patients due to index the detection process, hemodialysis, and no significant changes in condition, blood glucose (Glu), lipids, renal function, albumin, blood, calcium, phosphorus levels were not significantly different,(2) Serum ET-1, NO level, within a week after surgery decreased to levels began to rise after two weeks to three weeks after surgery returned to the preoperative level, no significant change after the fourth week,(3) Autogenous the third week after arteriovenous fistula, vascular endothelial damage repair basically completed, increase in blood flow within the fistula puncture gentle and meet demand.