彩色多普勒超声在尿毒症患者上肢动静脉内瘘术后成熟度评估中的应用

Application of Color Doppler Ultrasound in Assessing the Maturity of Upper Limb Arteriovenous Fistula in Patients with Uremia

目的:探讨彩色多普勒超声在尿毒症患者上肢自体动静脉内瘘(AVF)术后成熟度评估中的应用。方法:选取2020年7月—2023年6月贵溪市中医院收治的78例尿毒症血液透析患者为研究对象,均行上肢AVF术。采用彩色多普勒超声测定手术前后桡动脉和头静脉管径及血流量情况,术后6周根据内瘘成熟度标准将患者分为成熟组和未成熟组,并比较两组血管和血流量情况,绘制受试者操作特征(ROC)曲线评估桡动脉和头静脉血流量对AVF成熟度的诊断价值。结果:术后1、3、6周,患者桡动脉血流量(RVF)、桡动脉血管直径(RAD)、桡动脉收缩期峰值流速(RPSV)、头静脉血流量(CVF)、头静脉血管直径(CVD)、头静脉收缩期峰值流速(CPSV)均逐渐升高,与术前比较,差异均有统计学意义(P<0.05),桡动脉血流阻力指数(RRI)和头静脉血流阻力指数(CRI)均逐渐降低,与术前比较,差异均有统计学意义(P<0.05)。成熟组RAD、RPSV、CVD和CPSV均高于未成熟组,RRI和CRI均低于未成熟组,差异均有统计学意义(P<0.05)。术后6周CAD、CPSV和CRI联合预测AVF成熟曲线下面积(AUC)、敏感度、特异度分别为0.942、94.5%、87.0%,RAD、RPSV和RRI联合预测AUC、敏感度、特异度分别为0.919、83.6%、91.3%。结论:通过彩色多普勒超声测量尿毒症患者上肢AVF术后头静脉和桡动脉血管和血流参数,可以用于评估内瘘成熟程度。

Objective:To explore the application of color Doppler ultrasound in assessing the maturity of upper limb autogenous arteriovenous fistula(AVF)after surgery in patients with uremia.Method:A total of 78 uremic hemodialysis patients treated in Guixi Hospital of Traditional Chinese Medicine from July 2020 to June 2023 were selected.Color Doppler ultrasound was used to measure the diameter and blood flow of the radial artery and cephalic vein before and after upper limb AVF surgery.At 6 weeks postoperatively,patients were divided into mature group and immature group based on AVF maturity criteria,and the vascular and blood flow conditions of the two groups were compared.Receiver operator characteristic(ROC)curves were drawn to evaluate the diagnostic value of radial artery and cephalic vein blood flow for AVF maturity.Result:At 1,3 and 6 weeks postoperatively,radial artery volume flow(RVF),radial artery diameter(RAD),and radial artery peak systolic velocity(RPSV),as well as the cephalic vein blood flow(CVF),cephalic vein diameter(CVD),and cephalic vein peak systolic velocity(CPSV)increased significantly,compared with those before operation,the differences were statistically significant(P<0.05).The radial artery resistance index(RRI)and cephalic vein resistance index(CRI)decreased significantly,compared with those before operation,the differences were statistically significant(P<0.05).In the mature group,RAD,RPSV,CVD and CPSV were higher,and RRI and CRI were lower than those in the immature group(P<0.05).At 6 weeks postoperatively,the combined prediction of CAD,CPSV and CRI for AVF maturity had an area under the curve(AUC)and sensitivity,and specificity of 0.942,94.5%and 87.0%respectively,while the combined prediction of RAD,RPSV and RRI had an AUC,sensitivity,and specificity of 0.919,83.6%and 91.3%,respectively.Conclusion:Measuring the vascular and blood flow parameters of the cephalic vein and radial artery with color Doppler ultrasound after upper limb AVF surgery in uremic patients can be used to assess AVF maturity.