超声检查在难建前臂动静脉内瘘血液透析患者中的应用

Evaluation of arteriovenous fistula difficultly established for hemodialysis with color doppler ultrasound

目的分析彩色多普勒超声在较为困难建立的血液透析患者前臂动静脉内瘘中的作用。方法分析总结32例临床认为建立前臂动静脉造瘘较为困难的血液透析患者,超声在选择适宜的吻合动脉、静脉,确定吻合部位,造瘘术后评价动静脉内瘘血流情况与内瘘并发症中的作用。结果受检者桡动脉几乎能满足手术需要,有时管壁粗糙,可有粥样硬化斑块形成。选择管腔比较清晰、管壁较为光滑、有血流充盈的前臂浅静脉进行造瘘手术,以静脉直径大于或等于2.5mm、动脉直径大于或等于2.0mm为符合做内瘘的标准,静脉需明确较大的分支走形,测定支数目,确定吻合部位。造瘘术后动脉平均内径(0.25±0.09)cm,静脉平均内径(0.31±0.1)cm,瘘口处内径(0.22±0.07)cm,静脉血流量为(255±67)mL/min。主要并发症为吻合口狭窄、血管腔内血栓形成、周围组织血肿压迫、血管扭曲、静脉瘤、假性动静脉瘤形成。结论彩色多普勒超声在建立血液透析患者动静脉内瘘中,对术前血管的选择、吻合口部位的确定以及造瘘术后评价动静脉内瘘血流情况,分析内瘘并发症有重要作用。

Objective To evaluate the effect of color Doppler ultrasound in difficult arteriovenous fistula for hemodialysis. Methods To evaluate the effect of color Doppler ultrasound in selecting adequacy artert and vein before operation of arteriovenous fistu- la,and analysis of hemodynamic status and complications after operation in 32 pationts with arteriovenous fistula difficultly established in clinic for hemodialysis. Results The radial artery in the patients always would content the requirement of arteriovenous fistula establishment,in despite of the wall of blood vessel roughness and the formation of atheromatous plaque. The upper limbs vein with velvet wail and filling with blood stream was selected for the operation. The diameter of the vein was ≥2.5mm,and that of the artery was ≥2.0mm. The venous embranchment was observed and the position of of arteriovenous anastomos is determined before the operation. The average diameter of veins were（0. 31±0.1）cm,and of artery were （0, 25±0.09）cm,and of arteriovenous anastomos were（0.22± 0.07）cm. The average volume of veins were（255 ±67）mL/min. The main postoperative complications involved in were anastomosis stricture, thrombus happened, hemangioma of vien, blood vessel oppressed with haemotoma femoral arterial or venous pseudoaneurysms happented. Conclusion Color Doppler ultrasound plays an important role in choosing adequacy arter and vein before operation of arteriovenous fistula, and analysis of hemodynamics and complications after operation in the pationts with arteriovenous fistula difficultly established in clinic for hemodialysis.