终末期肾病患者上肢动静脉超声评估的基线特征

Baseline characteristics of arm vessels evaluated by ultrasonography in end stage renal disease patients

目的利用超声检查探索终末期肾病患者上肢血管的基线特征,以期为我国动静脉内瘘的建立提供借鉴。方法收集2016年7月~2020年5月在浙江大学医学院附属邵逸夫医院拟建立血液透析血管通路的终末期肾病患者307例。利用彩色多普勒超声评估上肢血管的基线特征,包括主要静脉的充盈内径、主要动脉的内径、内中膜厚度、钙化情况以及血流动力学参数。结果307例患者前臂头静脉、上臂头静脉、前臂贵要静脉、上臂贵要静脉、肘正中静脉、肘部穿静脉的平均内径分别为(2.6±0.9)mm、(3.6±1.4)mm、(2.4±0.8)mm、(4.6±1.1)mm、(2.9±1.7)mm、(3.1±1.0)mm,上段肱动脉、下段肱动脉、上段桡动脉、下段桡动脉、上段尺动脉、下段尺动脉的平均内径分别为(4.1±0.9)mm、(4.1±0.7)mm、(2.7±0.6)mm、(2.0±0.5)mm、(3.6±0.6)mm、(1.7±0.5)mm。肱动脉、桡动脉、尺动脉的钙化发生率分别为8.8%、15.9%、23.4%,平均收缩期峰值流速分别为(63.7±19.2)cm/s、(60.6±20.9)cm/s、(58.2±20.4)cm/s,阻力指数均为(0.9±0.1)。肱动脉平均血流量为(55.1±36.9)ml/min。结论超声检查可以无创地评估患者的上肢血管条件,就血管内径而言,前臂头静脉、上臂头静脉、前臂贵要静脉、上臂贵要静脉、肘正中静脉、肘部穿支静脉中符合建立动静脉内瘘要求(≥2.0mm)的比例分别为79.5%、88.7%、70.7%、98.6%、73.3%、88.9%,下段肱动脉、下段桡动脉、下段尺动脉中符合建立要求(≥1.5mm)的比例分别为100.0%、89.6%、66.8%。

Objective To explore the baseline characteristics of arm vessels evaluated by ultrasonography in patients with end stage renal disease so as to provide the reference for creation of arteriovenous fistula.Methods A total of 307 patients with end stage renal disease treated in Sir Run Run Shaw Hospital from July 2016 to May 2020 were enrolled in this study.Duplex ultrasonography was used to evaluate the baseline characteristics of arm vessels,including internal diameter,intima-media thickness,calcification and hemodynamic parameters.Results The mean internal diameters(mean±SD)of forearm cephalic vein,upper arm cephalic vein,forearm basilic vein,upper arm basilic vein,median cubital vein and cubital perforating vein were(2.6±0.9)mm,(3.6±1.4)mm,(2.4±0.8)mm,(4.6±1.1)mm,(2.9±1.7)mm and(3.1±1.0)mm,respectively.The mean internal diameters(mean±SD)of upper brachial artery,lower brachial artery,upper radial artery,lower radial artery,upper ulnar artery,lower ulnar artery were(4.1±0.9)mm,(4.1±0.7)mm,(2.7±0.6)mm,(2.0±0.5)mm,(3.6±0.6)mm and(1.7±0.5)mm,respectively.The incidences of calcification in brachial artery,radial artery and ulnar artery were 8.8%,15.9%and 23.4%,respectively.The mean peak systolic velocities(mean±SD)in brachial artery,radial artery and ulnar artery were(63.7±19.2)cm/s,(60.6±20.9)cm/s and(58.2±20.4)cm/s,respectively.Resistance indexes were all(0.9±0.1).The mean flow volume(mean±SD)in brachial artery was(55.1±36.9)ml/min.Conclusion Duplex ultrasonography has the advantage of noninvasive method to evaluate the baseline characteristics of arm vessels.Our study shows that the percentages of internal diameters meeting the basic requirement of arteriovenous fistula creation(≥2.0mm)in forearm cephalic vein,upper arm cephalic vein,forearm basilic vein,upper arm basilic vein,median cubital vein and cubital perforating vein were 79.5%,88.7%,70.7%,98.6%,73.3%and 88.9%,respectively;the percentages of internal diameters meeting the basic requirement of arteriovenous fistula creation(≥1.5mm)in brachial artery,radial artery and ulnar artery were 100.0%,89.6%and 66.8%,respectively.