摘要
目的利用彩色多普勒超声术前评估桡动脉、头静脉,选择最佳造瘘部位;术后监测桡动脉-头静脉瘘(RCF)是否成功和成熟状况,对瘘失败进行监测和预测。方法手腕部桡动脉-头静脉端-侧吻合手术的尿毒症患者68例,随机分成超声检查组33例(检查组)和物理检查组35例(对照组)。检查组观察手术前、术后1周及术后6个月桡动脉和头静脉的频谱特点、血管内径及血流动力学参数。结果检查组手术成功率(90.3%)高于对照组(80%)。RCF手术后1周的桡动脉内径、头静脉内径、收缩期峰值、舒张期峰值、平均速度、血流量均明显高于术前,阻力指数(RI)和搏动指数(PI)均明显低于术前。术后6个月比术后1周的头静脉内径和血流量明显增加。RCF手术成功后血流及频谱特点为高速、低阻力频谱。RCF失败者呈低速、高阻力特点。结论①术前超声多普勒对头静脉、桡动脉的检查可以提高手术成功率;②术后超声检查可以提示动静脉瘘成功与否并及时发现狭窄或栓塞。③超声检查可以监测瘘管通畅情况,血管直径、血流速度、血流量、PI、RI等可以作为预测瘘管失败的重要参考。
Objective Using color Doppler ultrasound to evaluate the radial artery and cephalic vein, and to choose the best fistulas sites before operation, then observe the success rate of radial-cephalic fistulas （RCF）, maturation degree, and abortive RCFs. Methods Sixty-eight patients with chronic renal failure planned to create new permanent vascular accesses, in which 33 cases were chosen randomly to have ultrasound examination （examination group） and the other 35 cases received physical examination only （contral group）. Operative type was radio-cephalic end-to-lateral anastomosis on wrist. The ultrasound parameters included diameter of radial artery （RAD）, cephalic vein （CVD）, peak systolic velocity （PSV）, end-diastolic velocity （EDV）, mean velocity （MV）, pulsatility index （PI）, resistance index （RI） and blood flow （BF） of radial artery. Ultrasound examinations were performed pre-operatively, 1 week and 6 months post-operatively in the examination group, respectively. Results The success rate of operation was higher in examination group （90.3 %） than in control group （80%）. RAD and CVD, PSV, EDV, MV and BF were higher, while PI and RI were lower by statistic significantly, comparing one week post-operation with pre-operation. CVD and BF increased significantly after 6 months compared with those after 1 week. The characteristic of Doppler and flow of blood in radial artery in successful RCF was high velocity and low RI like whirling flow. The characteristic of RCF in abortive group was high RI. Conclusion ①Examinations on radial artery and cephalic vein before operation could improve success rate and avoid missing the dysfunction and thrombosis. ②Examinations on radial artery and cephalic vein after operation could show whether the fistulas were successful, and whether the stenosis or the thrombus could be found on time. ③The failure in the accesses could be predicted by ultrasound measurement of the diameter, velocity, blood flow, PI and RI.
出处
《中国医学影像技术》
CSCD
北大核心
2006年第5期718-721,共4页
Chinese Journal of Medical Imaging Technology
关键词
超声检查
多普勒
彩色
肾透析
动静脉瘘
血流动力学
Uhrasonography, Doppler, color
Renal dialysis
Arteriovenous fistula
Hemodynamics
