Isometric exercise increases the size of forearm veins in patients with chronic renal failure
Isometric exercise increases the size of forearm veins in patients with chronic renal failure
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DOI：
10.1097/00000441-200303000-00003
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发表时间：
2003-03-01
影响因子：
3.1
通讯作者：
Kraut, J
中科院分区：
文献类型：
--
作者：
Leaf, DA;Macrae, HSH;Kraut, J
目的：Cimino-Brescia内瘘成熟延迟或成熟失败导致慢性血液透析患者的显著血管通路相关发病率。在血管通路形成之前，自体静脉的尺寸和容量增加被认为是自体瘘成功率的重要变量。我们评估了正式的锻炼计划是否会改变原生静脉的大小。研究方法：在5例重度慢性肾功能衰竭患者中评价了运动对静脉大小的影响[肾小球滤过率，30.6 +/- 5.3 mL/min（平均值+/- SD）]。5名平均年龄为57 ± 9岁的男性患者接受了为期6周的前臂运动训练计划，包括非优势臂，其中包括等长握力收缩至MVC的25 - 35%，持续40 - 120秒，以及重复挤压壁球和球拍球。根据握把测力计测量的力量和患者指示的舒适度，每周增加运动训练的量和强度。在6周的运动训练计划之前和之后，使用多普勒超声获得了非优势（训练）和优势（对照）手臂的头部血管尺寸，有和没有止血带。结果如下：与对照组相比，在没有止血带（0.048 +/- 0.016 vs 0.024 +/- 0.023 cm（2））和有止血带（0.056 +/- 0.022 vs 0.028 +/- 0.027 cm（2））的情况下，运动组手臂头静脉的大小显著增加（P < 0.05）。结论：这些发现表明，一个简单的，增加阻力，运动训练计划可以导致显着增加的头静脉的大小通常用于创建动静脉瘘。尺寸的增加和由此可能导致的血流量的增加可能会加速自体动静脉内瘘的成熟，从而降低与血管通路相关的发病率。
Objectives: Delay in maturation or failure of maturation of Cimino-Brescia fistulae contributes to the significant vascular access-related morbidity of chronic hemodialysis patients. Increased size and capacitance of native veins before the formation of vascular access has been considered an important variable in the success rate of native fistulae. We evaluated whether a formal exercise program might alter the size of native veins. Methods: The effect of exercise on venous size was evaluated in 5 patients with severe chronic renal failure [glomerular filtration rate, 30.6 +/- 5.3 mL/min (mean +/- SD)]. Five male patients with a mean age of 57 +/- 9 years underwent a 6-week forearm exercise training program, involving nondominant arms, that included isometric hand-grip contractions to 25 to 35% of MVC lasting 40 to 120 seconds and repetitive squeezing of squash and racquet balls. Both the volume and intensity of exercise training was increased weekly based on strength measured by hand-grip dynamometer and on the patients' indicated level of comfort. Cephalic vessel size in both the nondominant (trained) and dominant (control) arms, with and without a tourniquet, were obtained using Doppler ultrasound before and after the 6-week exercise training program. Results: The size of the cephalic vein of the exercised arm increased significantly (P < 0.05) compared with the control arm when measured in both the absence (048 +/- 0.016 versus 0.024 +/- 0.023 cm(2)) and the presence of a tourniquet (0.056 +/- 0.022 versus 028 +/- 0.027 cm(2)). Conclusions: These findings indicate that a simple, incremental resistance, exercise-training program can cause a significant increase in the size of the cephalic vein commonly used in the creation of an arteriovenous fistula. The increase in size and resultant probable increase in blood flow might accelerate the maturation of native arteriovenous fistulae, thereby lessening the morbidity associated with vascular access.