NCE-MRA在评价血液透析患者自体桡动脉-头静脉内瘘成熟的可行性研究

Application of NCE-MRA in the Radial Artery-Cephalic Vein Fistula Maturation of Hemodialysis Patients

目的探讨应用非增强磁共振血管成像(NCE-MRA)评价血液透析患者自体桡动脉-头静脉内瘘(RCF)术后血流动力学变化及RCF成熟的可行性。方法选取行RCF手术的血液透析患者共20例,所有患者均行NCE-MRA检查,测量其手术前1天及术后14天、28天桡动脉及头静脉的直径和血流量、吻合口的直径、头静脉内膜厚度及距皮深度。采用单因素方差分析比较患者手术前1天及术后14天、28天相关指标(桡动脉、头静脉的直径及血流量、头静脉内膜厚度)组间差异。采用配对t检验比较患者手术后14天、28天吻合口的直径、头静脉距皮深度之间的差异。结果 20例患者均获得随访,NCE-MRA随访至术后28天,临床随访至术后50天。RCF患者术后28天均达到成熟标准,成熟率100%。28天后进行血液透析,每周3次,透析时泵控实际血流量均>200 mL/min。50天内未出现血流量不足、狭窄、感染等并发症。RCF手术后桡动脉、头静脉直径及血流量在14天内增长迅速,术后14~28天增长较前平稳。手术后14天桡动脉、头静脉直径和血流量较术前1天差异有统计学意义(P<0. 01);术后14天与28天组间差异均无统计学意义(P>0. 05)。头静脉内膜厚度手术前1天、后14天和28天差异均无统计学意义(P>0. 05)。吻合口直径术后14天与28天差异无统计学意义(P>0. 05)。头静脉距皮深度术后14天与28天差异无统计学意义(P>0. 05)。结论 NCE-MRA可以为血液透析患者RCF术后成熟评估提供可靠参考,血流动力学参数变化对预估RCF成熟与否有一定参考价值。

Objective To investigate the hemodynamic changes after autologous radial artery-cephalic vein fistula(RCF)and evaluating the postoperative RCF maturation by NCE-MRA. Methods A total of 20 hemodialysis patients who underwent vascular access surgery from September to December 2017 were selected. All patients underwent NCE-MRA examination. The diameter and blood flow of the radial artery and cephalic vein,the diameter of the anastomotic stoma,the thickness of the cephalic vein and its distance to the skin were measured 1 day before surgery and 14 and 28 days after surgery. One-way analysis of variance(ANOVA) was used to compare the differences between 1 day before surgery and 14 and 28 days after surgery(radial artery and cephalic vein diameter and blood flow,and cephalic vein intimal thickness). Paired t test was used to compare the diameter of the anastomosis and the depth of the cephalic vein from the skin at 14 th to 28 th days after operation. Results All 20 patients were followed up. NCE-MRA follow-up extends to the 28 th day after surgery and clinically followed up to the 50 th day. All RCF patients reached the maturity standard on the 28 th day after surgery,and the maturation rate was 100%. After 28 days,hemodialysis was performed 3 times a week. The measured blood flow was more than 200 mL/min in dialysis. There were no complications like insufficient blood flow,stenosis,and infection within 50 days. The NCE-MRA examination showed that the diameter and flow rate increased rapidly within 14 days after RCF,and increased more steadily from the14 th to 28 th days after surgery than before.The diameter and flow of the radial artery and cephalic vein on the 14 th day after RCF were significantly different from those on the 1 st day before surgery(P<0. 01). There was no significant difference in the diameter and flow of the radial artery and cephalic vein between the 14 th and 28 th d(P>0.05). The thickness of the cephalic vein intima showed no significant difference before and after surgery(14 thd,28 thd)(P>0.05). There was no significant difference in the diameter of anastomosis between the 14 th and 28 th d(P>0.05). There was no significant difference in the cephalic vein’s distance to the skin between the 14 th day and 28 th day after surgery(P>0.05). Conclusion NCE-MRA can provide a reliable reference for the assessment of the maturity of RCF in hemodialysis patients,and hemodynamic parameter changes have certain reference value for predicting the maturity of RCF.