新建腕部桡动脉-头静脉内瘘窃血现象与流量分布分析

TThe steal blood phenomenon and flow distribution of newly created arteriovenous radial-cephalic wrist fistula

目的通过多普勒超声观察新建腕部桡动脉-头静脉内瘘,记录窃血现象和血流量,分析血流分布及流量与窃血现象的相关性。方法纳入44例腕部桡动脉-头静脉端侧吻合患者。患者均为术后2~6周。多普勒超声评估吻合口近端桡动脉血流量、吻合口远端桡动脉血流量和头静脉血流量。彩色多普勒超声评估吻合口两侧桡动脉血流方向,判断患者有无窃血现象。根据有无窃血,将患者分为正向血流组和反流组,比较2组各血管血流量。结果反流组35例患者,窃血现象发生率79.5%,正向血流组9例患者。2组患者血流量比较,吻合口近端桡动脉血流比较差异有统计学意义,正向血流组明显高于反流组(t=-2.899,P=0.006)。吻合口远端桡动脉血流比较差异有统计学意义(t=2.040,P=0.048),正向血流组低于反流组。反流组头静脉平均流量为(500.31±191.49)ml/min,正向血流组头静脉平均流量为(452.22±170.50)ml/min,2组流量比较差异无统计学意义(t=0.680,P=0.500)。反流组35例患者中,仅1例出现通路相关性缺血综合征,流量显示,吻合口远端桡动脉流量>吻合口近端桡动脉流量。结论窃血现象是动静脉内瘘术后普遍存在的现象,而吻合口远端桡动脉反向血流(窃血)对内瘘成熟有重要意义。

Objective The newly created arteriovenous radial-cephalic wrist fistula was observed by Doppler ultrasonography and the blood flow and steal blood phenomenon were recorded,in order to investigate the correlation between blood flow distribution in the fistula and steal blood phenomenon.Methods Forty-four patients with end-to-side radial-cephalic wrist fistula operation for 2~6 weeks were recruited in this study.Doppler ultrasonography was used to measure the blood flow in proximal radial artery,distal radial artery and cephalic vein of the fistula.Steal blood phenomenon was evaluated by color Doppler ultrasonography.According to the steal blood phenomenon,the patients were divided into retrograde flow in the distal radial artery group(groupⅠ)and antegrade flow in the distal radial artery group(groupⅡ).The blood flow in the proximal and distal radial arteries and cephalic vein of the fistula were compared between the two groups.Results Retrograde flow in the distal radial artery was found in 35 patients(groupⅠ)with the steal blood phenomenon rate of 79.5%.Antegrade flow in the distal radial artery was found in 9 patients(groupⅡ).The blood flow in the proximal radial arteries of anastomosis orifice was significantly higher in groupⅡthan in groupⅠ(t=-2.899,P=0.006).In contrast,the blood flow in the distal radial arteries of anastomosis orifice were significantly lower in groupⅡthan in groupⅠ(t=2.040,P=0.048).The mean blood flow in the cephalic veins had no statistical difference between groupⅡand groupⅠ(452.22±170.50 ml/min vs.500.31±191.49 ml/min;t=0.680,P=0.500).In the 35 patients with retrograde flow in the distal radial artery(groupⅠ),one patient developed dialysis access induced ischemia syndrome,and the blood flow in the distal radial artery was higher than that in the proximal radial artery of anastomosis orifice.Conclusion Steal blood phenomenon is frequently found in arteriovenous fistula.Retrograde flow in the distal radial arteries(steal blood phenomenon)is critical for the maturation of arteriovenous fistula.