Author/Editor		Knehtl, Maša; Krajnc, Mitja
Title		Vpliv arteriovenske fistule kot žilnega pristopa za hemodializo na prekrvljenost distalnih struktur - dlani in prstov (ocena treh parametrov)
Translated title		Influence of the arteriovenous fistula as hemodialysis vascular access on the perfusion of distal structures - palms and fingers (estimation of three parameters)
Type		članek
Source		Med Razgl
Vol. and No.		Letnik 43, št. 3
Publication year		2004
Volume		str. 203-17
Language		slo
Abstract		Hemodialysis is the most widely used method of renal replacement therapy in end-stage renal disease. It requires a reliable permanent vascular access and arteriovenous fistule (AVF) is the most commonly used method. Among other complications, it may cause hand (palm and fingers) ischemia (incidence 1-10%) as a result of altered hemodynamic circumstances in the area. Hand ischemia is manifested by typical signs and symptoms, especially in patients wich preexisting factors. The objective was to estimace the clinical significance of the measured parameters (skin temperature between the thumb and forefinger, skin temperature between the thumb and middle finger, skin temperature in the palm crease, pulse oxymetry, dynamometry) in dealing with a patient who has hand perfusion problems as a consequcnce of AVP. The significance of dynamometry and skin temperature is yet to be established. There is not a definite answer about the value of pulse oxymetry. Perspective measurements of the above-mentioned parameters were performed on 78 randomly selected end-stage renal disease patients who at the time of measurement did not have any manifest signs/symptoms of hand ischemia, on both hands. The first measurement was dune just before AVF creation (n=18), the second one in the first 24 hours following AVF creation (n=18), the third between the 2nd and the 5th month following AVF creation (n=9), the fourth between the 6th and the 9th month (n=7) and the last one (fifth) was done between the 10th and the 13th month following AVF creation. The average vulues of the chosen parameters on the fistular hand were lower (with a few exceptions) then on the nonfistular hand (measurements 2-5). For measurements 2-5, the average values on the fistular hand were Iower than the values obtained during the first measurement on a fistular hand. (Abstract truncated at 2000 characters).
Summary		Hemodializa, ki je najbolj razširjena metoda nadomestnega ledvičnega zdravljenja pri kronični ledvičnni odpovedi, zahteva zanesljiv trajni žilni pristop. Arteriovenska fisiula (AVF) je najpogosteje uporabljani žilni pristop, katerega zaplet je med drugim tudi ishemija roke - pojavnost se giba med 1-10%. Ishemija se pojavi kot posledica spremenjenih hemodinamskih sprememb na fistulnem področju in se kaže z značilnimi simptomi in znaki, zlasti pri bolnikih s prej obstoječimi dejavniki. Namen naloge je bil oceniti klinični pomen treh izbranih merjenih parametrov (temperature kože: med palcem in kazalcem, palcem in sredincem, v pregibu dlani, pulzne oksimetrije, dinamometrije) pri obravnavi bolnika z motnjami prekrvavitve roke, ki so posledica vzpostavitve AVF. V literaturi pomen dinamometrije in temperature kože ni ovrednoten, za pulzno oksimetrijo pa ni dokončnega odgovora. Meritve izbranih parametrov smo opravljali pri 18 bolnikih s kronično ledvično odpovedjo na fistulni in nefistulni roki v različnih časovnih obdobjih: 1. meritev pred vzpostavitvijo AVF (n=18), 2. meritev v enem dnevu po vzpostavitvi, 3. v obdobju prvih 4 mesecev (n=9), 4, v obdobju 5-8 mesecev (n=7) in 5. meritev v obdobju 9-12 mesecev (n=6). Povprečja merjenih parametrov na fistulni roki so bila (z nekaj izjemami) nižja od povprečij na nefistulni roki (meritve 2-5), povprečja na fistulni roki pri meritvah 2-5 pa nižja kot pri 1. meritvi na fistulni roki, vendar statistično pumembnih razlik pri nobeni od metodološko upravičenih primerjav nismo ugotovili (p>0,05; dvostranski parni Studentov t-test).
Descriptors		KIDNEY FAILURE, CHRONIC HEMODIALYSIS ARTERIOVENOUS SHUNT, SURGICAL HAND ISCHEMIA OXIMETRY MUSCLE CONTRACTION BODY TEMPERATURE