高频彩超在行动静脉内瘘术肾病患者中的应用

Application of high frequency color Doppler ultrasound in patients with nephropathy receiving arteriovenous fistula surgery

目的:探讨高频彩超在行动静脉内瘘术终末期肾病患者中的应用价值.方法:回顾性分析我院肾内科2015-2017年179例行动静脉内瘘术的维持性血液透析患者.术前采用高频彩超评估血管条件,筛选不适合手术血管;术后采用高频彩超监测血管成熟情况及内瘘狭窄、血栓等并发症的发生率.结果:静脉内径≥1.2 mm,动脉内径≥1.5 mm的血管适合进行自体动静脉内瘘吻合.血流量在500~600 ml/min,既能满足透析要求,又能降低内瘘术后并发症的发生.有12例静脉内径在1.0~1.2 mm,但静脉充盈良好,在握拳加压1 min后内径能达2.0 mm者,手术亦成功,术后内瘘流量达标.1例术后2+个月使用内瘘时无法满足透析要求,改行中心静脉cuff管透析.1例术后2年出现造瘘侧上肢肿胀,检查提示中心静脉狭窄.8例出现内瘘血栓,6例内瘘狭窄.结论:在行动静脉内瘘术的终末期肾病患者中,高频彩超对于术前血管的评估,术后血管的成熟情况及并发症的监测具有较高的应用价值.

Objective:To explore the application value of high frequency color Doppler ultrasound in patients with end-stage renal disease receiving arteriovenous fistula surgery.Methods:179 patients with maintenance hemodialysis via arteriovenous fistula from 2015 to 2017 were retrospectively analyzed.High-frequency color Doppler ultrasound was used to evaluate the condition of blood vessel before operation,and then screened the unsuitable vessels for operation.It was also used to monitor the maturation of blood vessel and the incidence of complications such as stenosis and thrombosis of internal fistula.Results:Vein diameter(≥1.2 mm)and artery diameter(≥1.5 mm)were suitable for autologous arteriovenous fistula anastomosis.The blood flow of 500-600 ml/min can not only meet the requirements of dialysis,but also reduce the incidence of complications after internal fistula surgery.In 12 cases,the internal diameter of veins was 1.0-1.2 mm,but the filling of veins was good and the internal diameter of veins reached 2.0 mm after 1 minute of pressure with fist clenching,the operation was also successful and the flow rate of internal fistula reached the standard.One case failed to meet the dialysis requirements when using internal fistula 2+months after operation,and changed to central venous cuff tube dialysis.One case developed upper limb swelling on the fistula side 2 years after operation,and the examination showed central venous stenosis.There were 8 cases of internal fistula thrombosis and 6 cases of internal fistula stenosis.Conclusion:In patients with end-stage renal disease receiving arteriovenous fistula surgery,high-frequency color Doppler ultrasound is of great value in the evaluation of preoperative blood vessels,the monitoring of vascular maturation and complications after operation.