自体动静脉内瘘术后成熟度的评估

Evaluation of the maturity after arteriovenous fistula

目的通过彩色多普勒超声技术观察前臂腕部动静脉内瘘(AVF)建立后的血流动力学变化,对AVF术后成熟度进行评估。方法按照入选和排除标准选择拟新建前臂自体头静脉-桡动脉端侧内瘘的慢性肾衰竭患者,应用彩色多普勒超声技术测量患者术前及术后1天、14天、28天和56天桡动脉和头静脉直径、流量以及头静脉内膜厚度和距皮肤深度,观察其变化趋势,评估AVF成熟度。2014年5月至2014年9月共入组21例,男性12例,女性9例,平均年龄(54.3±13.2)岁。结果 21例患者均获得随访,随访时间为70天,AVF均已穿刺透析,达到临床成熟标准。彩色多普勒超声检查结果显示:术后1天和14天时桡动脉和头静脉的直径和流量增幅最大,有显著差异(P<0.01),其后增幅缓慢,术后28天和56天无显著差异(P>0.05)。术后28天头静脉直径(5.0±1.0)mm,流量(1593.7±572.9)ml/min。术后头静脉距皮肤深度无统计学差异(P>0.05)。结论 AVF的成熟有赖于术前完善的血管评估,多普勒超声可用来判断AVF术后的成熟度。

Objective To evaluate the maturity of the wrist arteriovenous fistula（AVF） based on the measurement of the radial artery and cephalic vein by duplex. Methods The patients with end stage renal disease who needed the construction of a radiocephalic wrist AVF were enrolled in this study prospectively.The Duplex ultrasound scan was performed. The diameter and the flow of the radial artery and the cephalic vein, and the cephalic vein intimal thickness and the depth of the cephalic vein were measured just before AVF construction and 1, 14, 28, 56 days after AVF construction. 21 patients in Renji hospital from May2014 to December 2014 were enrolled,12 males and 9 females with mean age of 54.3±13.2 years old. Results All cases were followed up for 70 days,and all AVF reached the level of maturation and used for hemodialysis. The ultrasound showed that the increase in the diameter and blood flow rate of the radial artery and the cephalic vein was most dramatic on 1- and 14-day after AVF construction（P〈0.01）, but increase becomed slower on 28 and 56-day after AVF construction（P〉0.05）. As the internal diameter and blood flow rate of the cephalic vein were（5.0±1.0） mm and（1593.7±572.9） ml / min at 28-day after AVF construction,respectively. There was no statistically significant difference in the depth of the cephalic vein from the skin（P〉0.05）. Conclusion The AVF maturity is based on the evaluation of the radial artery and cephalic vein before the construction. The maturity after arteriovenous fistula can be measured by ultrasound.