彩色多普勒超声评估动静脉内瘘的成熟

Color Doppler ultrasonographic evaluation on the maturation of arteriovenous fistulas

目的尝试应用彩色多普勒超声动态监测桡动脉-头静脉内瘘(RCF)围手术期患者血流动力学参数变化是否可以预测其成熟。方法选择首次拟行RCF患者共22例,分别于术前和术后第2、4、6、8、10、12、14天用彩色多普勒超声测量头静脉、桡动脉和肱动脉的血流动力学参数:横截面积(A)、收缩期峰值流速(PSV)、舒张期峰值流速(EDV)、阻力指数(RI)、平均流速(TAM)、血流量(VF)。根据术后6周内临床透析穿刺检验分为成熟组和不成熟组。计算术后14d各血流动力学参数的中位数的均数。结果成熟组手术前后桡动脉及肱动脉VF、PSV及EDV显著升高而RI显著降低,不成熟组手术前后桡动脉及肱动脉血流动力学参数无统计学差异。术后头静脉血流量对RCF成熟预测的ROC曲线下面积0.982,标准误为0.026,其95%的近似参考置信区间为0.931～1.034,VF阈值为263.25ml/min。结论 RCF术后2周彩色多普勒超声检查有助于预测RCF成熟与首次通畅性。

Objective To prospectively determine whether the hemodynamic changes of radio- cephalic arteriovenous fistulas （RCF） peri-operative color Doppler ultrasonographic surveillance can predict the maturation. Methods Twenty-two patients with end stage renal disease were enrolled in this study prospectively. The patients＇ hemodynamic parameters of radial artery,brachial artery and cephalic vein which including A, PSA, EDV, RI, TAM and VF were measured with a portable duplex ultrasound unit before the operation and on the 2nd,4th ,6th, 8th, 10th, 12th, 14th day post-operation. According to the result of elinieal dialysis examination, patients were divided into two groups during 6 weeks postoperation：the mature group and the immature group. The means of medians of the post-operative hemodynamie parameters were calculated respectively. Results In mature group, the preoperative and post-operative hemodynamic parameters of radial and braehial artery were regarded as statistically significant. VF, PSV and EDV were significantly higher after RCF. RI was significantly lower after RCF. In immature group, the preoperative and post-operative hemodynamic parameters of radial and brachial artery were regarded no significance. The ROC area of post- operative cephalic VF was 0. 982 and the stand error was 0. 026 with the asymptotic 95% confidence interval （0. 931, 1. 034 ）. The threshold of cephalic VF to predict RCF maturation was 263. 25 ml/min. Conclusions Color Doppler ultrasonographic examinations may predict RCF maturation and primary adequacy for dialysis during the first 2 weeks after the operation.