多普勒超声下儿童移植肾动脉血流增快35例分析

Analysis of 35 cases of accelerated renal artery flow rate in pediatric kidney transplantation under Doppler ultrasound

目的移植肾动脉狭窄可能导致高血压等严重并发症,甚至移植肾丢失。多普勒超声是筛查移植肾动脉狭窄的常用手段。儿童肾移植中,在多普勒超声下检出移植肾动脉收缩期峰值流速(以下简称"动脉流速")增快比例明显高于成人。方法我们总结分析了本院近年来64例儿童肾移植中出现动脉流速增快以及确诊动脉狭窄的情况,总结分析了动脉流速增快发现时间、最快流速与血压升高、肌酐升高之间的关系。结果64例儿童肾移植中曾经出现过动脉流速增快的共35例。其中不明显增快的和明显增快的各有16例和19例;有血压升高、血肌酐升高等临床表现的共12例,无相关临床表现的为23例。有明确影像学证据的动脉狭窄5例,球囊扩张术治疗可取得良好效果。结论动脉流速增快是儿童肾移植常见现象,大多数与之相关的高血压、血肌酐升高等临床表现仅一过性出现,极少数发展为动脉狭窄。多数动脉流速增快,可暂不积极处理并予密切监测。保守治疗无效时,再考虑血管造影下球囊扩张等积极治疗方法,可取得较好疗效。

Objective Stenosis of the graft arteries may lead to serious complications such as high blood pressure and even loss of the graft.Doppler ultrasonography is a simple and effective method for screening renal artery stenosis.In pediatric renal transplantation,the rate of increased flow velocity of transplanted renal artery was significantly higher than that of adult under Doppler ultrasound.Methods In this paper,we summarized 64 cases of pediatric renal transplantation in our hospital,who showed the increased flow rate of renal artery and were diagnosed of arterial stenosis.We analyzed the relationship between the detection time of the increased flow rate,the maximum flow rate,the increase of blood pressure and creatinine.Results Thirty-five of the 64 pediatric renal grafts had increased arterial flow rate.There were 16 cases with no obvious velocity increase and 19 cases with obvious velocity increase,respectively.There were 12 cases with elevated blood pressure,serum creatinine and other clinical manifestations,while 23 cases had no related clinical manifestations.Balloon dilation was effective in cases of arterial stenosis with clear imaging evidence.Conclusion Increased arterial velocity in renal graft is a common phenomenon in pediatric kidney transplantation.Most of the clinical manifestations,such as hypertension and serum creatinine increase,are only transient,and only a few of them develop artery stenosis.