对血液透析患者应用阻力运动与血流限制和血栓形成风险的关注。

IF 9.7 1区 医学 Q1 HOSPITALITY, LEISURE, SPORT & TOURISM Journal of Sport and Health Science Pub Date : 2024-07-01 Epub Date: 2024-03-01 DOI:10.1016/j.jshs.2024.02.006
Hugo de Luca Corrêa, Lysleine Alves Deus, Dahan da Cunha Nascimento, Nicholas Rolnick, Rodrigo Vanerson Passos Neves, Andrea Lucena Reis, Thais Branquinho de Araújo, Carmen Tzanno-Martins, Fernanda Silveira Tavares, Luiz Sinésio Silva Neto, Cláudio Avelino Rodrigues Santos, Paolo Lucas Rodrigues-Silva, Fernando Honorato Souza, Vitória Marra da Motta Vilalva Mestrinho, Rafael Lavarini Dos Santos, Rosangela Vieira Andrade, Jonato Prestes, Thiago Dos Santos Rosa
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引用次数: 0

摘要

背景:血液透析(HD)本身就是血栓形成的一个危险因素。考虑到在血液透析患者中进行血流限制(BFR)运动的证据越来越多,为了确保这种训练模式的安全性和可行性,需要确定与促血栓形成因子 D-二聚体有关的可能风险因素。本研究旨在确定与较高 D-二聚体水平相关的风险因素,并确定阻力运动(RE)与 BFR 对该分子的急性影响:260名血液透析患者自愿参加了这项研究(所有患者的肾小球滤过率均低于15 mL/min/1.73m2)。RE+BFR训练包括在50分钟的血液透析过程中施加50%的动脉闭塞压力(透析内运动)。RE重复包括同心和偏心抬举阶段(各持续2秒),并由力量和调理专家进行监督:有几个变量与 D-二聚体水平升高有关,包括血糖较高、使用枸橼酸盐、近期发生过心血管事件、近期发生过交叉感染、炎症较重、导管作为血管通路、年龄较大的患者(大于 70 岁)和 HD 年份。此外,RE + BFR 会在 4 小时后明显增加 D-二聚体。基线 D-二聚体水平处于边缘(400-490 纳克/毫升)的患者 D-二聚体升高超过正常范围(>500 纳克/毫升)的风险增加:这些结果确定了与血栓前状态升高有关的因素,可能有助于对希望接受 RE + BFR 的 HD 患者进行筛查。作为一项预防措施,应在基线和整个方案中对 D-二聚体和/或其他纤溶因子进行评估,以最大限度地提高 RE + BFR 期间的安全性。
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Concerns about the application of resistance exercise with blood-flow restriction and thrombosis risk in hemodialysis patients.

Background: Hemodialysis (HD) per se is a risk factor for thrombosis. Considering the growing body of evidence on blood-flow restriction (BFR) exercise in HD patients, identification of possible risk factors related to the prothrombotic agent D-dimer is required for the safety and feasibility of this training model. The aim of the present study was to identify risk factors associated with higher D-dimer levels and to determine the acute effect of resistance exercise (RE) with BFR on this molecule.

Methods: Two hundred and six HD patients volunteered for this study (all with a glomerular filtration rate of <15 mL/min/1.73 m2). The RE + BFR session consisted of 50% arterial occlusion pressure during 50 min sessions of HD (intradialytic exercise). RE repetitions included concentric and eccentric lifting phases (each lasting 2 s) and were supervised by a strength and conditioning specialist.

Results: Several variables were associated with elevated levels of D-dimer, including higher blood glucose, citrate use, recent cardiovascular events, recent intercurrents, higher inflammatory status, catheter as vascular access, older patients (>70 years old), and HD vintage. Furthermore, RE + BFR significantly increases D-dimer after 4 h. Patients with borderline baseline D-dimer levels (400-490 ng/mL) displayed increased risk of elevating D-dimer over the normal range (≥500 ng/mL).

Conclusion: These results identified factors associated with a heightened prothrombotic state and may assist in the screening process for HD patients who wish to undergo RE + BFR. D-dimer and/or other fibrinolysis factors should be assessed at baseline and throughout the protocol as a precautionary measure to maximize safety during RE + BFR.

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来源期刊
CiteScore
18.30
自引率
1.70%
发文量
101
审稿时长
22 weeks
期刊介绍: The Journal of Sport and Health Science (JSHS) is an international, multidisciplinary journal that aims to advance the fields of sport, exercise, physical activity, and health sciences. Published by Elsevier B.V. on behalf of Shanghai University of Sport, JSHS is dedicated to promoting original and impactful research, as well as topical reviews, editorials, opinions, and commentary papers. With a focus on physical and mental health, injury and disease prevention, traditional Chinese exercise, and human performance, JSHS offers a platform for scholars and researchers to share their findings and contribute to the advancement of these fields. Our journal is peer-reviewed, ensuring that all published works meet the highest academic standards. Supported by a carefully selected international editorial board, JSHS upholds impeccable integrity and provides an efficient publication platform. We invite submissions from scholars and researchers worldwide, and we are committed to disseminating insightful and influential research in the field of sport and health science.
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