血管超声维护性筛查在早期诊断动静脉内瘘狭窄中的应用

Periodic examinations using vascular ultrasound for the early detection of arteriovenous fistula stenosis

目的 探讨定期血管超声检查在早期发现动静脉内瘘狭窄中的应用.方法 选择第三军医大学附属大坪医院血液净化中心2010年1月～2012年12月期间未用血管超声行动静脉内瘘定期筛查（A组）和2013年1月～2015年12月期间定期采用血管超声筛查的血液透析患者（B组）,回顾分析内瘘术后至使用2年期间内瘘狭窄的发现率、首次发现内瘘狭窄的程度及由狭窄导致的内瘘闭塞和血栓形成等,并统计B组患者内瘘狭窄的基本情况.结果 共收集符合条件的A组154例和B组178例患者,其中A组发现内瘘狭窄9例,发现率为5.8％,而B组为27例,发现率为15.2％,两组差异显著（x2=6.491,P=0.010）;首次发现内瘘狭窄的轻、中、重程度A组分别为0、1、8例,B组分别为25、2、0例,其中轻、重度两组差异有统计学意义（x2=21.419,P＜0.001;x2=6.985,P＜0.001）;A组患者内瘘闭塞和血栓形成分别为6例和9例,而B组为1例和2例,两组间比较差异有统计学意义（内瘘闭塞x2=3.233,P=0.046;血栓形成x2=4.364,P=-0.037）;A组内瘘狭窄的患者经皮球囊扩张介入治疗的3例,内瘘重建术6例,B组需要经皮球囊扩张介入治疗的5例,暂不需要特殊干预的22例.B组狭窄类型均为Ⅰ型狭窄,而狭窄长度为1mm的21例,2mm的6例,距离瘘口均小于5cm,与穿刺点距离在5～8cm为19例. 结论 定期血管超声普查能够早期排查到内瘘狭窄的发生,又能实时的反应出瘘管狭窄的部位和范围,为临床早期干预提供依据,从而延长内瘘使用寿命.

Objective To investigate periodic vascular ultrasound examinations for the early detection of stenosis in arteriovenous fistula （AVF） in hemodialysis patients. Methods The hemodialysis patients with AVF and treated in the Hemodialysis Center of Daping Hospital during the period from Jan. 2010 to Dec. 2015 were enrolled in this study. They were divided into group A （patients treated during Jan. 2010 to Dec. 2012 and without periodic vascular ultrasound examinations） and group B （patients treated during Jan. 2013 to Dec. 2015 and with periodic vascular ultrasound examinations）. AVF stenosis rate, stenosis degree at the first examination, AVF stenosis derived occlusion and thrombosis within the two years after AVF surgery were retrospectively analyzed. In addition, AVF stenosis degree in group B was also reviewed. Results AVF stenosis was found in 8 cases （5.8%） in group A （n=154）, and in 27 cases （15.2%） in group B （n=178） （X^2=6.491, P=- 0.010）. At the first examination, slight, mild and severe AVF stenoses were detected in 0, 1, and 8 cases respec- tively in group A, and in 25, 2, and 0 cases respectively in group B, with statistical significance in cases of mild and severe stenoses between the two groups （X^2=21.419, P〈0.001; X^2=6.985, P〈0.001）. AVF occlusion and thrombosis in AVF were found in 6 and 9 cases respectively in group A, and in 1 and 2 cases respectively in group B （X^2=3.233, P=0.046 for AVF occlusion; X^2=4.364, P=0.037 for thrombosis in AVF）. Percutaneous transluminal angiography to treat AVF stenosis was performed for 3 cases in group A and for 5 cases in group B. AVF must be re-constructed for 6 cases in group A. In contrast, intervention of the stenoses was not needed in 22 cases in group B. In group B, all of the stenoses were of type I stenoses, with the stenosis length of lmm in 14 cases and 2 mm in 2 cases; the distance between stenosis and AVF orifice was 〈5cm in 14 cases, and the distance between stenosis and puncture site was 5-8cm in 13 cases. Conclusion Periodic examination for AVF function by vascular ultrasound can early detect AVF stenosis and its location and range in hemodialysis patients, useful for the early intervention ofAVF stenosis and the extension of AVF life.