超声对前臂动静脉内瘘成熟前后血管内径、血流量评价

doi:10.7517/issn.1674-0475.210924

摘要/Abstract

摘要： 本文探讨超声评估透析患者前臂自体动静脉内瘘(AVF)成熟前后血管内径、血流量变化及意义。选取109例接受前臂AVF成形术终末期肾病透析患者作为研究对象,根据术后8周内瘘是否成熟分为成熟组(n=68)和未成熟组(n=41),比较两组临床资料、术前和术后8周头静脉、桡动脉血管内径、血流量,并对数据进行分析处理。结果显示,两组术后8周头静脉、桡动脉血管内径、血流量均高于术前,且成熟组高于未成熟组(P<0.05);多因素Logistic回归分析显示,头静脉、桡动脉血管内径、血流量仍与内瘘成熟相关(P<0.05);头静脉和桡静脉血管内径、血流量联合评估内瘘成熟的ROC曲线下面积(AUC)大于单独的参数,评估价值最高;头静脉、桡动脉血管内径、血流量高水平患者成熟率高于低水平者(P<0.05)。可见前臂AVF成熟后头静脉和桡动脉内径、血流量明显增加,采用超声检测AVF成形术前与术后以上血管的变化,可作为评估内瘘成熟的一个标准,为临床选取穿刺透析时机提供参考。

关键词: 超声, 透析, 前臂自体动静脉内瘘, 内瘘成熟, 血管内径, 血流量

Abstract: This article explored the changes and significance of the blood vessel diameter and blood flow before and after the maturation of the autogenous arteriovenous fistulas (AVF) in the forearm of dialysis patients. A total of 109 end-stage renal disease dialysis patients receiving forearm AVF angioplasty were selected as the research objects. According to whether the fistula was mature within 8 weeks after operation, they were divided into mature group (n=68) and immature group (n=41). The clinical data of the two groups were compared. The internal diameter and blood flow of the cephalic vein and radial artery before and 8 weeks after the operation, and the data were analyzed and processed. The results showed that the internal diameter and blood flow of the cephalic vein and radial artery in the two groups were higher than that before the operation at 8 weeks after operation, and the mature group was higher than that of the immature group (P<0.05); multivariate logistic regression analysis showed that the cephalic vein and radial Arterial vessel diameter and blood flow are still related to fistula maturity (P<0.05). The area under the curve (AUC) of the combined assessment of cephalic vein and radial vein vessel diameter and blood flow for fistula maturity is greater than the individual parameters. The evaluation value is the highest; the maturity rate of patients with high level of cephalic 275 vein and radial artery diameter and blood flow is higher than that of low level (P<0.05). It can be seen that the internal diameter and blood flow of the cephalic vein and radial artery after the mature AVF of the forearm are significantly increased. The use of ultrasound to detect the changes of blood vessels before and after AVF angioplasty can be used as a standard for evaluating the maturity of internal fistulas and provide a reference for clinical selection of puncture dialysis timing.

Key words: ultrasound, dialysis, forearm autogenous arteriovenous fistula, mature internal fistula, vascular diameter, blood flow

谢静, 王春杰. 超声对前臂动静脉内瘘成熟前后血管内径、血流量评价[J]. 影像科学与光化学, 2022, 40(2): 275-279.

XIE Jing, WANG Chunjie. Ultrasound Evaluation of Blood Vessel Diameter and Blood Flow before and after the Maturation of Forearm Arteriovenous Fistula[J]. IMAGING SCIENCE AND PHOTOCHEMISTRY, 2022, 40(2): 275-279.

参考文献

[1] 欧月秀, 秦曙光, 林昌平, 等. 血液透析病人自体动静脉内瘘失功能危险因素的Logistic回归分析[J]. 安徽医药, 2019, 23(1):72-75.
[2] Venkatnarayanan R, Dogra P M, Bavdekar R, et al. Primary failure of autogenous arteriovenous fistula:Critical analy-sis[J]. Journal of Nephrology, 2020, 30(6):382-390.
[3] 柯媛, 唐敏. 彩色多普勒超声对血液透析患者动静脉内瘘结构功能评估及并发症诊断价值[J]. 川北医学院学报, 2019, 34(4):377-380.
[4] Franco G, Mallios A, Bourquelot P, et al. Ultrasound evaluation of percutaneously created arteriovenous fistulae between radial artery and perforating vein at the elbow[J]. Journal of Vascular Access, 2020, 21(5):694-700.
[5] 中国医院协会血液净化中心管理分会血液净化通路学组. 中国血液透析用血管通路专家共识(第1版)[J]. 中国血液净化, 2014, 13(8):549-558.
[6] 中国中西医结合学会肾脏疾病专业委员会. 慢性肾衰竭中西医结合诊疗指南[J]. 河北中医, 2016, 38(2):313-317.
[7] Lee J S, Kim J H, Park S C, et al. Clinical aspects of percutaneous transluminal angioplasty for autogenous arteriovenous fistula dysfunction:An early period experience[J]. Asian Journal of Surgery, 2020, 43(3):508-510.
[8] Lopes J R A, Marques A L B, Correa J A. The influence of a doppler ultrasound in arteriovenous fistula for dialysis failure related to some risk factors[J]. Jornal Brasileiro De Nefrologia, 2020, 42(2):147-152.
[9] Lee J, Lee S, Chang J W, et al. Clinical value of intraoperative flow measurements of brachiocephalic arteriovenous fistulas for hemodialysis[J]. Journal of Thoracic and Cardiovascular Surgery, 2020, 53(3):121-126.
[10] Zhang D, Zhang Z, Wan L, et al. Characteristics of non-mature but functional autogenous radiocephalic fistulas in hemodialysis patients:A prospective cohort study[J]. Journal of Vascular Access, 2020, 21(5):636-645.
[11] Hou G, Hou Y, Sun X, et al. Venous distensibility is more important than venous diameter in primary survival of autogenous radiocephalic arteriovenous fistulas[J]. Journal of Vascular, 2020, 21(6):963-968.
[12] El Khoury R, Russeau A P, Patel N, et al. Reliability of preoperative venous mapping ultrasonography in predicting for autogenous arteriovenous fistula maturation[J]. Journal of Vascular Surgery, 2021, 73(5):1787-1793.
[13] 王仡豪, 郁胜强. 血液透析用血管通路国内外指南的比较分析[J]. 中国血液净化, 2019, 18(5):332-334.
[14] Arhuidese I J, AJi E A, Muhammad R, et al. Racial differences in utilization and outcomes of hemodialysis access in the Unites States[J]. Journal of Vascular Surgery, 2020, 71(5):1664-1673.
[15] Misskey J, Hamidizadeh R, Faulds J, et al. Influence of artery and vein diameters on autogenous arteriovenous access patency[J]. Journal of Vascular Surgery, 2020, 71(1):158-172.e1.
[16] 陈琰, 赵艳玲, 陈冬蔚, 等. 基质金属蛋白酶-2联合彩色多普勒超声在评估自体动静脉内瘘血管成熟中的价值[J]. 中国中西医结合肾病杂志, 2020, 21(4):337-339.