高频超声对血液透析动静脉内瘘头静脉血流量的监测价值

The value of high frequency ultrasound in monitoring blood flow of cephalic vein in arteriovenous fistula after dialysis

目的:探讨高频超声对血液透析患者动静脉内瘘头静脉血流量的监测价值,分析头静脉血流量并得出提示动静脉内瘘功能异常的最佳阈值。方法:按照临床标准将透析患者分为两组,其中自体动静脉内瘘功能正常组30例,功能异常组30例。通过高频超声测量患者肱动脉与头静脉的血流量,记录相应数值并计算其平均值。比较内瘘功能正常组与功能异常组间头静脉血流量是否有差异,应用ROC曲线对所有患者肱动脉及头静脉血流量进行分析,比较两指标预测内瘘功能的价值,分析利用超声监测头静脉血流量提示动静脉内瘘功能异常的最佳阈值。结果:动静脉内瘘功能正常组头静脉血流量与功能异常组头静脉血流量两者均数比较,差异有统计学意义(P<0.01),通过ROC曲线分析得到头静脉血流量曲线下面积大于肱动脉血流量指标曲线下面积,分析得到头静脉血流量提示动静脉内瘘功能异常的最佳阈值为342.5m L/min。结论:利用高频超声测量头静脉血流量对预测内瘘功能有较大的意义;在预测内瘘功能方面,头静脉血流量指标好于肱动脉;头静脉提示内瘘功能异常的最佳阈值为342.5ml/min。

Objective： To investigate the value of high frequency ultrasound in monitoring the blood flow of arteriovenous fistula in hemodialysis patients,analyze the blood flow of cephalic vein and get the best threshold to indicate the insufficiency of Arteriovenous fistula. Methods： Dialysis patients in two groups,including 30 cases of normal Arterio-Venous Fistula（ AVF） group and 30 cases of insufficient AVF group according to the clinical classification criteria,paticipated in this study.. The blood flow of brachial artery and cephalic vein in two groups was measured by high frequency ultrasound,and the corresponding values were recorded and means were calculated. The difference in the blood flow of cephalic vein between the normal AVF group and insufficient AVF group was compared,the blood flow of brachial artery and cephalic vein in all patients were analyzed using ROC curve analysis. The value in prediction of AVF function between two indicators was compared,the best threshold of reminding insufficient AVF using ultrasound to monitor head vein blood flow was determined. Results： The difference in the blood flow of cephalic vein between normal AVF group and deficient AVF group was significant statistically（ P〈0.01） The result of ROC curve analysis showed that the area under the curve in the blood flow of cephalic vein was larger than that of brachial artery blood flow,and the best threshold that blood flow of cephalic vein indicating abnormal function of AVF was 342. 5 m L/min. Conclusion：Using high frequency ultrasonic to measure the blood flow of cephalic vein has great significance for prediction of AVF function. In the prediction of the AVF function,the index in the blood flow of cephalic vein was better than that in brachial artery index,the best threshold that blood flow of cephalic vein indicating abnormal function of AVF was 342. 5 ml/min.