前臂腕部自体动静脉内瘘建立后的动脉重构研究

Artery remolding following the creation of native arteriovenous fistula on the wrist

目的 探讨前臂腕部自体动静脉内瘘建立后动脉系统血管重构的特点.方法 研究对象来自河北医科大学第三医院肾内科接受初次行前臂腕部自体动静脉内瘘成形术的患者31例,应用彩色多普勒超声测量术前及术后1日、1周、2周、4周时的肱动脉、桡动脉及尺动脉内径,峰值血流速,血流量及阻力指数,观察其变化趋势.结果 28例患者完成连续性观测.平均年龄(53.68±2.61)岁.内瘘位置左前臂21例;原发病为糖尿病者12例.肱动脉、桡动脉还是尺动脉,在前臂自体动静脉内瘘建立后,均发生了血管内径增大,峰值血流速度增快,血流量增加,阻力指数下降的变化.其中桡、尺动脉的内径变化幅度大于肱动脉(P<0.001);桡动脉峰值血流速、血流量及阻力指数的变化幅度均大于肱动脉及尺动脉(P<0.001).结论 自体动静脉内瘘建立后,动脉系统会发生动脉内径增大,峰值血流速增快,血流量增加,阻力指数下降的变化,其中桡动脉的变化最为剧烈.

Objective To find out the characters of artery remolding following the creation of autogenous arteriovenous fistula. Methods A total of 31 patients receiving creation of native arteriovenous fistula on the wrist were reviewed. Doppler ultrasound was used to monitor the diameter, peak flow velocity, flow rate and resistant index of brachial artery, radial artery and ulnar artery at the time before the surgery, one day, one week, two weeks and four weeks after the surgery, respectively. The tendency of the diameter change was analyzed. Results Twenty eight patients completed the whole monitor session. The average age of those patients was 53.68 ±2.61 years old. Twenty one patients' fistula located on the left arm. Twelve of them were diabetic nephropathy. The diameter, peak flow velocity, flow rate of all the artery were increased after surgery (P<0.01). The resistant index of all the three artery decreased during the session (P<0.01). The diameter of radial artery and ulnar artery increased more than brachial artery (P<0.01) while the peak flow velocity, flow rate and resistant index of radial artery changed much obviously than the other two arteries ( P<0.01). Conclusions The diameter, peak flow velocity, flow rate and resistant index of brachial artery, radial artery and ulnar artery were all significantly changed after the surgery. The parameter were changed more obviously in radial artery than the other two.