自体动静脉内瘘局部血流动力学研究

Local hemodynamics of autologous arteriovenous fistula

目的探讨自体动静脉内瘘局部血流动力学特点及其影响因素。方法选择维持性血液透析（maintennance hemodialysis,MHD）患者71例,横断面分析,应用彩超测量自体动静脉内瘘瘘口直径,双侧上肢桡动脉、尺动脉、肱动脉内径及血流量,分析动静脉内瘘对双侧上肢局部血流动力学的影响。结果动静脉内瘘手术后1-144个月,术侧头静脉内径（6.67±2.18）mm；术侧肱动脉内径（5.59±1.24）mm,对侧肱动脉内径（3.81±0.72）mm；术侧桡动脉吻合口近心端内径（4.12±1.13） mm,吻合口远心端（2.84±0.90）mm,对侧桡动脉内径（1.93±0.46）mm；术侧尺动脉内径（2.21±0.86）mm,对侧尺动脉内径（1.64±0.58）mm；术侧和对侧相比,有统计学差异（P〈0.01）。术侧肱动脉血流量（2164.18±1413.06）ml/min,对侧肱动脉血流量（538.90±326.90）ml/min；术侧桡动脉血流量（1172.75±718.20）ml/min,对侧桡动脉血流量（106.50±75.83）ml/min；术侧尺动脉血流量（245.95±184.09）ml/min,对侧尺动脉近心端血流量（81.34±68.80）ml/min；术侧和对侧相比,有统计学差异（P〈0.01）。结论自体动静脉内瘘建立后,术侧肢体的肱动脉、尺动脉、桡动脉内径相应增粗,血流量增大。

Objective To investigate the local hemodynamics and influencing factors of autolo-gous arteriovenous fistula.Methods Seventy-one patients with maintenance hemodialysis（MHD） were chosen in the cross-section analysis.Color Doppler ultrasound was applied to measure the diame-ter of autologous arteriovenous fistula,the inner diameter of radial artery,ulnar artery and brachial artery.The influence of arteriovenous fistula on the local hemodynamics of bilateral upper extremity was analyzed.Results From the 1st to 144th month after arteriovenous fistula surgery,the inner diameter of cephalic vein on the operated side was （6.67±2.18）mm;The inner diameter of brachial artery on the operated side was （5.59±1.24）mm,and that on the opposite side was （3.81±0.72）mm;The in-ner diameter of radial artery close to heart on the operated side was （4.12±1.13）mm,that of its dis-tal end was （2.84±0.90）mm,and that on the opposite side was （1.93±0.46）mm;The inner diame-ter of ulnar artery on the operated side was （2.21±0.86）mm,and that on the opposite side was （1.64 ±0.58）mm.The comparsion between the operated side and the opposite side（P〈0.01）,showed sig-nificant difference.The blood flow of brachial artery on the operated side was （2 164.18±1 413.06） ml/min,and that on the opposite side was （538.90±326.90）ml/min;The blood flow of radial artery on the operated side was （1 172.75±718.20）ml/min,and that on the opposite side was （106.50± 75.83）ml/min;The blood flow of ulnar artery on the operated side was （245.95±184.09）ml/min, and that on the opposite side was （81.34±68.80）ml/min.The comparsion between the operated side andtheoppositeside,P〈0.01,showedsignificantdifference.Conclusions Afterarteriovenousfistu-la surgery,the inner diameter of brachial artery,ulnar artery and radial artery on the operated side is accordingly thinken,and the blood flow is increased.