超声在血液透析患者自体动静脉内瘘功能评估中的应用

Application of ultrasound in evaluating the function of autologous arteriovenous fistulae in hemodialysis

摘要:

目的：利用超声对血液透析患者自体动静脉内瘘（autologous arteriovenous fistulae，AVF）的功能状况进行评估，探讨其临床应用价值。方法：以46例初次建立AVF终末期肾脏病患者作为研究对象，于术前及术后2、4、6周对建立内瘘的桡动脉、头静脉进行超声监测，随访初次使用情况。结果：（1）桡动脉的管径（radial artery diameter，RAD）、桡动脉血流量（radial artery vol－ume flow，RVF）、头静脉管径（cephalic vein diameter，CVD）在术前，术后2、4、6周的差异有统计学意义（P均＜0.01），头静脉血流量（cephalic vein volume flow，CVF）在术后2周、4周、6周的差异有统计学意义（P＜0.01）；RVF、CVF在端侧与端端吻合者间的差异有统计学意义（P分别＜0.05、＜0.01）；时间与吻合方式对RAD、RVF、CVF存在交互作用（P分别＜0.05、＜0.01、＜0.01）。术后6周AVF成熟率87%，38例初次透析泵控血流量达标。（2）4例发生并发症。结论：超声可用于血液透析患者AVF的功能评估；端侧吻合较端端吻合更容易引起AVF的高流量。

Abstract:

Objective：To evaluate the function of autologous arteriovenous fistulae（AVF） in hemodialysis by ultrasound and to explore the value of ultrasound. Methods：Totally 46 patients with end-stage renal disease，who established AVF first，were enrolled in this study. Radial artery and cephalic vein of AVF before operation and at 2，4，6 weeks after operation were monitored by ultrasound. The circumstances of the first hemodialysis were follewed. Results：（1）Radial artery diameter（RAD），radial artery volume flow（RVF），cephalic vein diameter（CVD） were statistically different before operation and at 2，4，6 weeks after operation（P＜0.01）. Cephalic vein volume flow（CVF） was statistically different at 2，4，6 weeks after operation（P＜0.01）. There were statistical differences in RVF，CVF between patients with end-to-side and end-to-end anastomosis（P＜0.05，P＜0.01）. Interactive effects of time and anastomosis type on RAD，RVF and CVF were considered statistically significant（P＜0.05，P＜0.01，P＜0.01）. Mature rate of AVF was 87% at 6 weeks postoperatively. Pump controlling blood flows of 38 patients were enough in the first hemodialysis. （2）4 patients experienced complications. Conclusions：（1）Ultrasound can be used to evaluate the function of AVF in hemodialysis. （2）End-to-side anasto－mosis will more easily lead high flow of AVF.