肾功能衰竭患者造瘘术后血液透析灌注不足的超声图像分析

Analysis of ultrasonic images in renal failure patients with hemodialysis hypoperfusion after renal fistulation

目的分析肾功能衰竭(RF)患者动-静脉造瘘术后出现血液透析灌注不足的超声图像特征。方法彩色多普勒超声观察65例造瘘术后血液透析灌注不足RF患者头静脉、桡动脉及吻合口的内径、走形、彩色血流束及血流动力学参数,计算狭窄血管的狭窄度。结果 46例(70.77%)血栓形成;其中,完全闭塞16例,狭窄30例。14例(21.54%)吻合口瘢痕收缩;其中,高度狭窄8例,中度狭窄6例。2例(3.08%)吻合口手术狭窄,均为中度狭窄。3例(4.62%)局部血肿压迫;其中,1例闭塞,2例中度狭窄。结论血栓形成、吻合口瘢痕收缩、吻合口手术狭窄及局部血肿压迫是RF患者造瘘术后血液透析灌注不足的主要原因;血管闭塞及狭窄是造成灌注不足的血流动力学原因。

Objective To analyze the ultrasonic images of renal failure（RF）patients with hemodialysis hypoperfusion after renal fistulation.Methods The characteristics of diameter,shape,blood flow of cephalic vein,radial artery and anastomotic stoma,and hemodynamic parameters were observed by color Doppler ultrasound in 65 patients with RF.The degree of stenosis was measured.Results Forty-six（70.77%）cases were with thrombosis,of whom 16 cases had complete occlusion and 30 cases had stenosis.Forteen cases（21.54%）were with anastomotic scar contraction,of whom 8cases had severe stenosis and 6 cases had moderate stenosis.Two cases（3.08%） were with anastomotic operative stenosis in moderate degree.Three cases（4.62%）were with local hematoma compression,of whom one case had occlusion and 2 cases had moderate stenosis.Conclusion Thrombosis,anastomotic scar contraction,anastomotic operative stenosis and local hematoma compression are the reasons causing hemodialysis hypoperfusion after fistulation in patients with RF.Vascular occlusion and stenosis are the hemodynamic causes of hypoperfusion.