前臂腕部自体动静脉内瘘成熟状态的初步研究

Primary study in maturity status of native arteriovenous fistula on the wrist

目的 通过前瞻性观察前臂腕部自体动静脉内瘘穿刺使用时的头静脉内径,血流量及血管壁厚度,总结中国人内瘘成熟时的内瘘血管状态.方法 自体动静脉内瘘建立后由专业护理人员经验性判断穿刺时间定为拟成熟,并应用彩色多普勒超声监测血管状态.穿刺透析3次后没有出现透析血流量不足、透后出血时间延长、血肿等并发症者判定为成熟,超声测量的数据即定为成熟时的血管状态.结果 31例患者进入研究,30例患者最终判定为内瘘成熟.患者平均年龄（52.93±3.21）岁,女性患者13例,内瘘位置左前臂22例,原发病为糖尿病肾病者13例.术前平均头静脉内径（3.10±0.11）mm,术前头静脉血流量及管壁厚度超声无法测得.30例患者平均内瘘成熟时间（57.10±3.21）d.至内瘘成熟时,头静脉平均内径为（4.74±0.16） mm,较术前平均扩张（57.08±5.96）％,与K/DOQI指南推荐的6 mm相比差异有统计学意义（P＜0.05）.头静脉平均血流量（569.76±48.34）ml/min,与K/DOQI指南推荐的600 ml/min相比差异无统计学意义（P＞0.05）.平均头静脉壁厚度（0.95±0.04） mm.内瘘成熟时头静脉内径、血流量及管壁厚度95％可信区间的下限分别为4.44 mm、486.37 ml/min及0.67 mm.结论 我国维持性血液透析患者腕部自体动静脉内瘘成熟时的头静脉内径明显小于K/DOQI指南推荐的内径数值,我国维持性血液透析患者的内瘘成熟标准可能异于国外.

Object To investigate the maturity status of the cephalic vein when the native arteriovenous fistula matures and set up indicators of a matured native arteriovenous fistula.Methods The diameter,flow rate and wall thickness of the cephalic vein were prospectively measured by Doppler ultrasound after the native fistula was created.Mature judgment was done by skilled nurses depending on their experience before the fistula was punctured.The ultrasound data was marked as proposed mature at the same time.After three times dialysis,if blood flow was fluent and complications such as prolonged bleeding time and hematoma were absent,fistula mature was confirmed.Results Thirty-one patients were admitted to the study,then fistula were matured.The average age of those patients was （52.93±3.21） years old.Thirteen patients were female.Twenty two fistula located on the left arm.Thirteen of the patients were diabetic nephropathy.The average diameter of cephalic vein was increased from （3.10±0.11） mm before surgery to （4.74±0.16） mm when the fistula was matured,though it was still smaller than 6 mm which K/DOQI guideline had recommended （P ＜ 0.05）.The average mature period was （57.10±3.21） days.The matured fistula had an average high flow rate of （569.76±48.34） ml/min and wall thickness of （0.95±0.04） mm.The one-side 95％ credibility interval of the diameter,flow rate and wall thickness of cephalic vein was 4.44 mm,486.37 ml/min and 0.67 mm,respectively.Conclusions The diameter of cephalic vein in a matured native arteriovenous fistula in our study was significantly smaller than 6 mm which K/DOQI guideline had recommended.The indicators of native arteriovenous fistula mature in our country may different from abroad.