彩色多普勒超声对自体动静脉内瘘成型术血流动力学和内瘘成熟情况的临床价值

The clinical value of color Doppler ultrasound evaluation for the hemodynamics of autogenous arteriovenous fistula angioplasty and the maturation situation of internal fistula

目的:探讨彩色多普勒超声对评估自体动静脉内瘘成型术血流动力学和内瘘成熟情况的临床价值。方法:选取30例首次行动静脉内瘘手术的患者,对所有患者行彩色多普勒超声检查,比较手术前后患者头静脉和桡动脉相关血流动力学参数。术后2个月,根据内瘘成熟标准将其分为成熟组(22例)和未成熟组(8例),对比分析两组患者相关血流动力学数据情况。结果:术后1周、1个月和2个月收缩期峰值流速(PSV)和舒张期峰值流速(EDV)均有逐渐上升趋势;PSV与术前比较差异有统计学意义(t=11.135,t=8.231,t=11.068;P<0.05);EDV与术前比较差异有统计学意义(t=9.466,t=7.044,t=10.581;P<0.05);但术后1周、1个月和2个月差异无统计学意义(t=1.708,t=0.857,t=0.694;P>0.05),血管阻力指数(RI)由术前平均值0.72降为术后2个月的0.28,差异有统计学意义(t=8.176,P<0.05);术后1周患者桡动脉和头静脉直径均有所增加,与术前比较差异有统计学意义(t=9.13,t=10.05;P<0.05),术后1周桡动脉血流和头静脉血流均明显加快,差异有统计学意义(t=8.65,t=8.91;P<0.05)。术后1周、1个月和2个月之间桡动脉及头静脉血管直径和血流量比较,差异无统计学意义(t=1.24,t=0.93,t=1.02,t=0.85;P>0.05);术后2个月,动静脉内瘘成熟度为73.33%(22/30)。术后,成熟组血流速度明显加快、桡动脉直径明显增加。且术后成熟组PSV、EDV及RI与未成熟组比较,差异有统计学意义(t=10.08,t=8.17,t=12.36;P<0.05);彩色多普勒超声结果显示,吻合口近心端桡动脉内径、术后、术后1周、1个月桡动脉内径变化呈逐渐增加的趋势。结论:彩色多普勒超声可广泛用于动静脉内瘘手术患者对相关血管的评估,术后相关血流动力学参数能够有效评估动静脉内瘘成熟程度。

Objective:To investigate the clinical value of color Doppler ultrasound for evaluating the hemodynamics of autogenous arteriovenous fistula angioplasty and the maturation situation of internal fistula.Methods:30patients who firstly underwent surgery of arteriovenous fistula were enrolled in the study,and all of them received examination of color Doppler ultrasound.And the relevant hemodynamics parameter of cephalic vein and radial artery between before and after operation were compared,respectively.At the second months after operatation,all of patients were divided into maturity group(22cases)and immaturity group(8cases)according to mature standard of internal fistula.And then the data of hemodynamics between the two groups were further compared and analyzed.Results:The PSV and EDV were gradually increasing at the1week,1month and2months after surgery.The differences of PSV among preoperation and the1week,1month and2month post surgery were statistically significant(t=11.135,t=8.231,t=11.068,P<0.05),respectively.And the differences of EDV among them also were significant(t=9.466,t=7.044,t=10.581,P<0.05),respectively.However,the differences among the1week,1month and2month post surgery were no significant(t=1.708,t=0.857,t=0.694,P>00.05).The difference of vessel RI between preoperation(0.72)and the2month(0.28)postoperation was signifcant(t=8.176,P<0.05).The differences of the vein diameter of radial artery and cephalic vein between preoperation and1week postoperation were statistically significant(t=9.13,t=10.05,P<0.05),respectively.And the differences of the blood flow of radial artery and cephalic vein between preoperation and1week postoperation were statistically significant(t=8.65,t=8.91,P<0.05),respectively.And the differences of vein diameter and blood flow among1week,1month and2months postoperation were no significant(t=1.24,t=0.93,t=1.02,t=0.85,P>0.05).At the second month after surgery,the mature degree of arteriovenously internal fistula was73.33%(22/30).After surgery,the blood flow of maturity group was obviously fast and the diameter of radial artery was obviously increasing.The differences of PSV,EDV and RI after surgery between maturity group and immaturity group were significant(t=10.08,t=8.17,t=12.36,P<0.05).The results of color Doppler indicated that the changes of the internal diameter of the radial artery of anastomotic stoma at proximal part of heart,1week after surgery and1month after surgery have a gradually increasing trendency.Conclusion:The color Doppler can be widely used to assess the relevant vessel of patient who received the surgery of arteriovenous fistula.And the relevant parameter of hemodynamics at post surgery can effectively evaluate the mature degree of arteriovenous internal fistula.