彩色多普勒超声联合血管CT成像监测动静脉内瘘成熟程度的临床应用

Clinical application of color doppler ultrasonography and CT angiography for monitoring dynamic arteriovenous fistula maturity

目的探讨彩色多普勒超声和血管CT成像技术在该领域的应用价值指导建立动静脉内瘘和术后监测尿毒症患者前臂动静脉瘘的应用价值。方法对56例尿毒症患者造瘘术前及术后行彩色多普勒超声监测,选择适宜吻合血管及对人工动静脉瘘功能评价,螺旋CT血管成像技术进行检查内瘘血管的狭窄部位情况。结果造瘘术前动脉平均内径1.8～2.9(2.2±0.8)mm,静脉平均内径2.2～3.9(1.0±0.4)mm。5例患者出现内瘘血栓,狭窄和瘤样扩张,53例患者人工动静脉瘘血流动力学稳定,2月左右成熟,术后内瘘内径,血流量和血流速度逐渐增加,适用于穿刺进行血液透析。对3例超声难以定位内瘘障碍部位的患者进行CT成像,可精确发现狭窄部位,详细描述中心静脉情况,如锁骨下静脉,头臂干,上腔静脉是否有狭窄或血栓形成。结论彩色多普勒超声联合CT血管成像对人工动-静脉内瘘患者进行术前造瘘血管的选择和术后血管通路监测有重要的临床应用价值。

Objective To investigate the clinic value of color doppler uhrasonography and CT angiography in guiding the establishment of arterio-venous fistula and the evaluation of post arterio-venous fistula. Methods We have monitored 56 patients with end-stage renal failure and give suitable blood vessel to anastomosis. After operation, the function of arterio-venous fistula was evaluated by doppler ultrasonography. Results Before operations, the average internal diameter of artery was 1.8-2.9 （ 2. 2±0. 8 ） mm, average internal diameter of veins was 2. 2-3.9 （ 1.0 ± 0. 4 ） mm. 51 patients get the stable hemodynamics in the arte- rio-venous fistula except 5 patients with thrombus and bump type extension. The fistula mature in two months, the fistula flow and velocity increased which was applicable of hemodialysis. CT angiography could describe the information of brachiocephalic vein, superior vana cava, subclavian vein color doppler uhrasonography could evaluate the inner diameter of vessels at anastomosis site and vascular structure. Conclusion Color doppler ultrasonography play a important role in election of vessel before operation of arterio-venous fistula and in detection of fistula post-operation, CT angiography could be an alternative method to evaluate the fistu- la dysfunction.