彩色多普勒超声对自体动静脉内瘘成型术前血管的观察和评价

The value of vascular ultrasound for the pre-operative evaluation prior to arteriovenous fistula formation for haemodialysis

目的探讨彩超对自体动静脉内瘘成型术前血管观察和评价的临床价值。方法彩超观察101例拟行自体动静脉内瘘成型术患者的前臂血管,测量桡动脉及头静脉内径、流速等各项指标,并根据手术结果分组进行对比分析。结果 101例患者中89例接受手术,4个月后成功透析75例。据此分为成功及失败组分析发现,成功组及失败组术前桡动脉内径及峰值流速有统计学差异(2.266±0.410 mm vs.1.975±0.300 mm,P=0.017,t=2.434;0.706±0.165 m/s vs.0.558±0.241 m/s,P=0.009,t=2.686),而内膜中层厚度及反应性充血评价无统计学差异(0.319±0.073 mm vs.0.364±0.090 mm,P=0.081,t=1.770;0.778±0.078 vs.0.814±0.099,P=0.358,t=0.932)。成功组及失败组术前的头静脉内径无统计学差异(2.348±0.690 mm vs.2.221±0.765 mm,P=0.591,t=0.539);但头静脉较细者(<2mm)静脉充盈后内径有统计学差异(2.363±0.344 mm vs.1.987±0.096 mm,P=0.017,t=2.605)。结论自体动静脉内瘘成型术前应用彩超评估具有重要的作用,特别应注意测量桡动脉内径及峰值流速,对于头静脉内径偏细者,测量扩张后静脉内径有助于预测手术结果。

Objective To discuss the value of pre-operative vascular ultrasound evaluation of arteriove- nous fistula （AVF） formation for haemodialysis. Methods Vascular ultrasound was performed in 101 candi- dates for AVF. Factors such as diameter and velocity of radial artery and cephalic vein were analyzed accord- ing to the results of AVF operation. Results There were 89 patients among 101 candidates received AVF op- eration after ultrasound scan, and 75 cases had successful haemodialysis using AVF after 4 months. There was significant difference in diameters and peak systolic velocity of radial artery between successful and fail groups （2.266±0.410 mm vs. 1.975±0.300 ram, P=0.017, t=2.434; 0.706±0.165 m/s vs. 0.558±0.241 m/s, P= 0.009, t=-2.686）, while the intima-media thickness and the resistance index during reactive hyperemia were similar in two groups （0.319±0.073 mm vs. 0.364±0.090 ram, P=0.081, t=-1.770; 0.778±0.078 vs. 0.814± 0.099, P=0.358, t=0.932）. The diameter of cephalic vein was the same between two groups （2.348±0.690 mm vs. 2.221±0.765 mm, P=-0.591, r=-0.539）, but significant difference was found between diameters of conges- tive dilated veins and those with cephalic vein less than 2 mm （2.363±0.344 mm vs. 1.987）, but signP=0.017, t=2.605）. Conclusions Vascular ultrasound is valuable in pre-operative evaluation for arteriovenous fistula op- eration, especially evaluating the diameters and peak systolic velocity of radial artery and diameters of conges- tive dilated veins in those with cephalic vein less than 2 mm.