高频超声监测自体动脉静脉内瘘术后并发症的价值

The value of high-frequency ultrasound in monitoring postoperative complications of autologous arteriovenous fistula

目的:本研究旨在评价高频超声监测血液透析患者自体动静脉内瘘并发症的临床价值。方法:选取2019年1月—2020年6月进行血液透析的自体动静脉内瘘患者102例。应用高频超声检测头静脉、肱动脉血流动力学参数并评估并发症情况。以CTA检查结果为依据,绘制ROC曲线,分析各参数预测自体动静脉内瘘并发症的诊断效能。结果:以CTA检查结果为依据,102例患者中,内瘘结构正常者61例(59.80%),发生并发症者41例(40.20%)。并发症组头静脉内径、肱动脉内径、肱动脉流量均明显低于非并发症组(P<0.05)。并发症组肱动脉RI值明显高于非并发症组(P<0.05)。并发症组与非并发症组的头静脉PSV、肱动脉PSV差异无统计学意义(P>0.05)。头静脉内径、肱动脉内径、肱动脉流量及肱动脉RI值的ROC曲线下面积分别是0.67,0.82,0.85,0.92,最佳临界值分别为0.225 cm、0.495 cm、358 mL/min及0.625。结论:高频超声监测头静脉及肱动脉血流动力学参数有助于及时发现自体动静脉内瘘并发症,头静脉内径、肱动脉内径、肱动脉流量及肱动脉RI值在监测内瘘并发症中具有较好的诊断效能。当超声检测头静脉内径、肱动脉内径、肱动脉流量小于临界值或肱动脉RI值大于临界值时需引起重视。

Objective:To evaluate the clinical value of high-frequency ultrasound in monitoring complications of autologous arteriovenous internal fistula in hemodialysis patients.Methods:102 patients who underwent hemodialysis with autologous ateriovenous fistula in our hospital from January 2019 to July 2020 were enrolled in this study.High-frequency ultrasound was used to detect cephalic vein diameter,brachial artery diameter and hemodynamic parameters and to evaluate complications(stenosis and thrombosis).Based on the results of CTA,ROC curve was used to analyze the diagnostic efficiency of parameters of responsibility vessels in predicting complications of autologous arteriovenous fistula.Results:Among these 102 patients,CTA showed 61 cases(59.80%)had normal arteriovenous fistula structure and 41 cases(40.20%)had complications.The diameter of cephalic vein and brachial artery,flow volume of brachial artery in the complication group were significantly lower than those in the non-complication group(P<0.05).The brachial artery resistance index of the complication group was significantly higher than that of the non-complication group(P<0.05).There was no significant difference in peak flow velocity(PSV)of cephalic vein and brachial artery between the complication group and the non-complication group(P<0.05).The area under ROC curves of cephalic vein diameter,diameter and flow volume and RI value of brachial artery were 0.67,0.82,0.85 and 0.92,respectively.The best cut-off values respectively were 0.225 cm,0.495 cm,358 mL/min and 0.625.Conclusions:High-frequency ultrasonic monitoring of blood flow mechanics parameters of cephalic vein and brachial artery is helpful for detecting of complications of autologous arteriovenous fistula timely.Diameter of brachial artery diameter and cephalic vein brachial,flow volume and RI value of brachial artery have good diagnostic performance in monitoring internal fistula complications,especially brachial artery RI value.When the value of cephalic vein diameter,diameter and flow volume is lower than the best cut-off values,or the value of RI is higher than the best cut-off values,we should pay attention.