血管超声造影在指导困难动静脉内瘘建立中的应用效果

Application effect of vascular contrast-enhanced ultrasonography in guilding the establishment of difficult arteriovenous internal fistula

目的 探讨血管超声造影在指导困难动静脉内瘘建立中的应用效果。方法 前瞻性分析2014年8月~2015年8月102例存在困难动静脉内瘘的慢性肾脏病患者的资料,随机分为彩色超声组（n=50）和超声造影组（n=52）。比较两组的手术时间、术中出血量、吻合口直径、血流量、住院费用、术后内瘘成熟率、并发症发生率。结果 彩色超声组的手术时间较超声造影组延长[（148.2±13.6）min vs.（115.3±14.3）min）]（P=0.006）。彩色超声组的术中出血量较超声造影组增多[（31.2±6.6）ml vs.（19.2±5.8）ml]（P=0.012）。彩色超声组的吻合口直径小于超声造影组[（3.8±0.3）mm vs.（4.2±0.2）mm]（P=0.042）。彩色超声组的血流量少于超声造影组[（385.3±66.2）ml/min vs.（425.3±67.3）ml/min（P=0.004）。彩色超声组与超声造影组的住院费用比较差异无统计学意义[（1.8±0.3）万元vs.（1.9±0.3）万元]（P=0.246）。彩色超声组术后1个月内瘘成熟率低于超声造影组[70.00%（35/50）vs.88.46%（46/52）]（P=0.021）。彩色超声组术后3个月内瘘成熟率低于超声造影组[76.00%（38/50）vs.92.31%（48/52）]（P=0.024）。彩色超声组与超声造影组的术后总并发症发生率比较差异无统计学意义[18.00%（9/50）vs.5.77%（3/52）]（P=0.055）。超声造影组的血栓形成发生率显著低于彩色超声组[0 vs.12.00%（6/50）]（P=0.046）。结论 对于困难动静脉内瘘患者,血管超声造影优于彩色多普勒。

Objective To investigate the application effect of vascular contrast-enhanced ultrasonography in guilding the establishment of difficult arteriovenous internal fistula. Methods Data of 102 patients with chronic kidney disease having difficult arteriovenous internal fistula from August 2014 to August 2015 was prospectively analyzed.102 patients were divided into color Doppler group （n=50） and ultrasound contrast group （n=52）.Operation time,intraoperative blood loss,diameter of anastomotic stoma,blood flow volume,hospitalization expense,maturation rate of internal fistula after op- eration,and incidence rate of complication between two groups was compared espectively. Results Operation time in color Doppler group was significantly longer than that in ultrasound contrast group [（148.2±13.6） min vs. （115.3±14.3） min] （P=0.006）.Intraoperative blood loss in color Doppler group was more than that in ultrasound contrast group [（31.2±6.6） ml vs. （19.2±5.8） ml] （P=0.012）.Diameter of anastomotic stoma in color Doppler group was smaller than that in ultrasound contrast group [（3.8±0.3） mm vs. （4.2±0.2） mm] （P=0.042）.Blood flow volume in color Doppler group was less than that in ultrasound contrast group [（385.3±66.2） ml/min vs. （425.3±67.3） ml/min] （P=0.004）.There was no significant differ- ence in hospitalization expense between color Doppler group and ultrasound contrast group [（1.8±0.3） million yuan vs. （1.9±0.3） million yuan] （P=0.246）.Maturation rate of internal fistula after 1 month operation in color Doppler group was significantly lower than that in ultrasound contrast group[70.00% （35/50） vs. 88.46% （46/52）] （P=0.021）.Maturation rate of internal fistula after 3 months operation in color Doppler group was significantly lower than that in ultrasound con- trast group[76.00% （38/50） vs. 92.31% （48/52）] （P=0.024）.There was no significant difference in total incidence rate of com- plication between color Doppler group and ultrasound contrast group [18.00%（9/50） vs. 5.77% （3/52）] （P=0.055）.Incidence rate of thrombosis in ultrasound contrast group was significantly lower than that in color Doppler group [0 vs. 12.00% （6/50）] （P=0.046）. Conclusion Vascular contrast-enhanced ultrasonography was better than color Doppler for patients with difficult arteriovenous internal fistula.