彩色多普勒超声在尿毒症血液透析病人自体动静脉内瘘的术前目标血管选择及术后内瘘通道检测中的应用

The application of color doppler ultrasound in preoperative vascular selection and postoperative fistula detection in arteriovenous fistula

目的观察彩色多普勒超声在尿毒症血液透析病人行自体动静脉内瘘术前目标血管的选择及术后内瘘通道检测的应用价值。方法选取2014年5月至2017年9月南京市中心医院尿毒症病人49例,行动静脉造瘘术前双侧桡动脉、头静脉彩色超声检查,观察管壁的状况,测量内膜中层厚度、斑块大小、血管走形及分支的位置。动态观察术后2、4、8周头静脉内径、头静脉血流量的变化及各种并发症。术后8周根据内瘘成熟情况将其分为成熟组32例及不成熟组11例,对两组桡动脉内径及频谱血流动力学参数进行综合评定分析。结果术前检出不符合手术标准的病人6例,术后检出并发症11例,包括血栓3例,闭塞2例,静脉瘤样扩张1例,瘘口周围血肿1例,狭窄4例,内瘘成熟率为74.41%(32/43)。术后2、4、8周头静脉内径分别为(3.6±0.4)、(4.4±0.6)、(5.7±0.5)mm,血流量分别为(498.8±213.7)、(821.9±341.6)、(976.8±487.1)mL/min,均呈逐步上升趋势,且术后4、8周显著高于术后2周,差异有统计学意义。成熟组桡动脉内径、收缩期峰值流速(PSV)和舒张期末期流速(EDV)分别为(3.9±0.5)mm、(170.4±22.7)cm/s、(97.6±14.8)cm/s,不成熟组分别为(2.4±0.3)mm、(76.4±10.3)cm/s,(37.9±6.2)cm/s,成熟组较不成熟组均有显著增加,血管阻力指数(RI)成熟组(0.39±0.07),较不成熟组的(0.70±0.13)下降明显,差异有统计学意义。结论彩色多普勒超声在术前选择血管和术后动态监测内瘘通道成熟情况及可能出现的并发症方面具有较高的临床应用价值。

Objective To observe the value of color Doppler ultrasound(CDUS)in preoperative vascular selection and the postopera?tive fistula detection in hemodialysis patients.Methods Forty?nine patients with uremia underwent CDUS of bilateral radial artery and cephalic vein before arteriovenous fistula operation were enrolled.The condition of the wall was observed,and the thickness of the intima,que size,vascular path and branch position were measured by color doppler ultrasonography of bilateral radial artery and ce?phalic vein.The changes in cephalic vein diameter,venous blood flow and various complications at 2,4,and 8 weeks after surgery were observed dynamicly.At 8 weeks postoperatively,they were divided into mature group(32 cases)and immature group(11 cases)ac?cording to the maturity of arteriovenous fistula.The internal diameter and spectrum hemodynamic parameters of the two groups were comprehensively analyzed.Results Six patients who did not meet the surgical criteria were detected preoperatively.11 cases were di?agnosed as complication after operation,including 3 cases of thrombosis,2 cases of occlusion,1 case of venous tumor?like dilation,1 case of peripheral hematoma of fistula,and 4 cases of stenosis.After operation(2,4 and 8 weeks),the diameter[(3.6±0.4),(4.4±0.6),(5.7±0.5)mm]and blood flow of the cephalic vein[(498.8±213.7),(821.9±341.6),(976.8±487.1)mL/min]increased gradually,and the difference was statistically significant at 4 and 8 weeks after operation.In the mature group,the radial artery diameter[(3.9±0.5)mm vs.(2.4±0.3)mm],peak systolic velocity(PSV)[(170.4±22.7)cm/s vs.(76.4±10.3)cm/s]and end diastolic velocity(EDV)[(97.6±14.8)cm/s vs(.37.9±6.2)cm/s]were significantly increased than the immature group,and the vascular resistance index(RI)decreased signifi?cantly[(0.39±0.07)vs(.0.70±0.13)].The difference was statistically significant.Conclusion CDUS has a high clinical value in preop?erative vascular selection and postoperative dynamic monitoring of the maturity of internal fistula and possible complications.