摘要
目的探讨高频彩色多普勒超声在终末期肾病维持性血液透析自体动静脉内瘘(AVF)术后流量评估中的应用效果。方法回顾性分析2021年2月至2022年3月在安康市中医医院治疗的透析患者中首次行自体动静脉内瘘手术的82例患者的临床资料,手术部位均为腕部,手术方式均为端侧吻合,患者术后4周、8周、3个月分别行高频彩色多普勒超声检查,记录肱动脉、桡动脉、头静脉血流量及血流参数,比较不同时间点患者血流参数变化,并对比随访3个月内瘘成熟与未成熟患者、发生与未发生并发症患者血流参数差异。结果3个月随访期内内瘘成熟患者69例,未成熟患者13例,未成熟率为15.85%;术后不同时间点桡动脉内径、收缩期峰值流速、血流量水平随时间延长而增加,头静脉与肱动脉内径、收缩期峰值流速水平随时间延长而增加(P<0.05);内瘘成熟患者桡动脉、头静脉及肱动脉管径、收缩期峰值流速、血流量均大于未成熟患者,差异均有统计学意义(P<0.05);3个月随访期内,69例患者动静脉内瘘通畅无并发症,13例患者出现动静脉内瘘并发症(血栓形成9例,狭窄4例),血栓形成和狭窄患者的头静脉、桡动脉、肱动脉管径均小于无并发症患者,差异均有统计学意义(P<0.05);血栓形成和狭窄患者的头静脉、桡动脉收缩期峰值流速均低于无并发症患者,而头静脉、桡动脉血流量均低于无并发症患者,差异均有统计学意义(P<0.05);血栓形成、狭窄患者与正常无并发症者肱动脉血流量比较差异无统计学意义(P>0.05)。结论高频彩色多普勒超声可有效监测血液透析患者动静脉内瘘血流量,反映内瘘成熟度,对内瘘结构功能进行直接观察的同时还可明确诊断动静脉内瘘并发症,对于AVF流量评估,肱动脉流量优于头静脉流量。
Objective To explore the application effect of high-frequency color Doppler ultrasound in evaluating blood flow of autologous arteriovenous fistula(AVF)in patients with end-stage renal disease after maintenance hemodialysis.Methods A retrospective analysis was performed on the clinical data of 82 patients undergoing dialysis after AVF for the first time in Ankang Hospital of Traditional Chinese Medicine between February 2021 and March 2022.The surgical site and surgical method were wrists and end-to-side anastomosis,respectively.High-frequency color Doppler ultrasonography was conducted at 4 weeks,8 weeks,and 3 months after surgery.The blood flow and blood flow parameters of brachial artery,radial artery and cephalic vein were recorded.The changes of blood flow parameters at different time points were compared.The differences in blood flow parameters were compared between patients with mature and immature internal fistula,and between patients with and without complications within 3 months of follow-up.Results During 3 months of follow-up,there were 69 cases with mature internal fistula and 13 cases with immature internal fistula,with immature rate of 15.85%.As time went by after surgery,diameter,systolic peak velocity,and blood flow of radial artery were increased,and diameters and systolic peak velocity of cephalic vein and brachial artery were also increased(P<0.05).The diameters of radial artery,cephalic vein and brachial artery,peak systolic velocity,and blood flow in patients with mature internal fistula were significantly higher than those with immature internal fistula(P<0.05).During 3 months of follow-up,there were 69 cases without AVF complications and 13 cases with AVF complications(9 cases with thrombosis,4 cases with stenosis).The diameters of cephalic vein,radial artery,and brachial artery in patients with thrombosis and those with stenosis were shorter than those in patients without complications(P<0.05).Peak systolic velocity values of cephalic vein and radial artery were significantly lower than those in patients without complications(P<0.05),and blood flow of cephalic vein and radial artery was significantly less than that in patients without complications(P<0.05).There was no significant difference in blood flow of brachial artery among patients with thrombosis,patients with stenosis,and patients without complications(P>0.05).Conclusion High-frequency color Doppler ultrasound can effectively monitor blood flow of AVF and reflect the maturity of internal fistula in patients undergoing hemodialysis,which can directly observe the structure and function of internal fistulas,and clearly diagnose AVF complications.In terms of AVF flow assessment,blood flow of brachial artery is better than that of cephalic vein.
作者
刘雨杭
周伟
闫建锋
杨雪梅
李文丽
郝恒松
余洁
LIU Yu-hang;ZHOU Wei;YAN Jian-feng;YANG Xue-mei;LI Wen-li;HAO Heng-song;YU Jie(Department of Ultrasound,Ankang Hospital of Traditional Chinese Medicine,Ankang 725000,Shaanxi,CHINA;Department of Ultrasound,Ankang Central Hospital,Ankang 725000,Shaanxi,CHINA;Department of Nephrology,Ankang Hospital of Traditional Chinese Medicine,Ankang 725000,Shaanxi,CHINA)
出处
《海南医学》
CAS
2023年第12期1770-1773,共4页
Hainan Medical Journal
基金
陕西省社会发展科技攻关项目(编号:2018SF-237)。
关键词
终末期肾病
血液透析
高频彩色多普勒超声
自体动静脉内瘘
内瘘成熟度
并发症
End-stage renal disease
Hemodialysis
High-frequency color Doppler ultrasound
Autologous arteriovenous fistula
Maturity of internal fistula
Complication
