高频超声监测稳定血透患者动静脉内瘘并发症的临床价值再评价

丁红; 顾奇澜; 朱宇莉; 周志英; 白寿军

中国临床医学影像杂志 ›› 2015, Vol. 26 ›› Issue (2) : 118-121.

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高频超声监测稳定血透患者动静脉内瘘并发症的临床价值再评价

丁红1，顾奇澜1，朱宇莉2，周志英1，白寿军1

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Monitoring vascular complications on autogenous arteriovenous fistulas in hemodialysis patients: value of high-frequency ultrasound

DING Hong1, GU Qi-lan1, ZHU Yu-li2, ZHOU Zhi-ying1, BAI Shou-jun1

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摘要

目的：评价高频超声在监测维持性血透患者自体动静脉内瘘功能及其并发症中的价值。方法：选择临床血透病情稳定的前臂内瘘患者81例，彩色多普勒超声监测内瘘桡动脉段、头静脉段及吻合口的内径、峰值流速和阻力指数（RI），并测量肱动脉血流量参数。结果：超声显示45（55.6%）例内瘘结构正常，36（44.4%）例出现并发症，包括静脉瘤状扩张14例、血栓形成12例、盗血现象9例和假性动脉瘤1例；其中8（9.9%）例诊断内瘘狭窄，均为血栓形成所致。81例患者血流量参数范围203~2 390 mL/min，平均（1 146±410） mL/min；低流量组（<800 mL/min）和高流量组（≥1 500 mL/min）的并发症发生率明显高于中等流量组（P<0.05）。狭窄组血流量（375±124） mL/min明显低于无并发症组（P<0.05），狭窄段内径显著减小（P<0.05）；静脉段狭窄者，桡动脉和吻合口的RI均显著增高（P<0.05）。结论：临床血透病情稳定的自体动静脉内瘘也存在各种并发症，高频超声监测血流量和血流动力学参数是早期发现和诊断内瘘并发症的有效手段；对无临床症状而血流量<800 mL/min的患者需排除严重并发症，防止内瘘失功。

Abstract

Objective: To assess the value of high-frequency ultrasound in monitoring vascular complications on autogenous arteriovenous fistulas(AVF) in hemodialysis patients. Methods: Eighty-one patients with clinically normal hemodialysis access were examined with color Doppler ultrasound. The structure of AVF, peak systolic velocity, resistance index(RI) and blood flow volume of branchial artery were recorded. Results: Among 81 AVF patients, 45(55.6%) were normal in structure, and 36(44.4%) were abnormal including 14 venous dilatation, 12 thrombosis, 9 arterial steal symptom and 1 pseudoaneurysm. There were 8(9.9%) cases diagnosed as AVF stenosis due to thrombosis. The mean flow volume of all patients was (1 146±410) mL/min(203~2 390 mL/min). The incidence of vascular complications was higher in low(<800 mL/min) and high(≥1 500 mL/min) blood flow volume groups than in the middle volume group(P<0.05). The blood flow volume in stenosis cases was (375±124) mL/min, which was significantly lower than no complication group(P<0.05). There was also statistically significant difference in the diameter of stenostic vessels and the RI of radial artery and anastomosis between the stenosis group and no complication group(P<0.05). Conclusions: There are some vascular complications in clinically normal AVF patients, which can be monitored with high-frequency ultrasound based on its structure, blood flow volume and hemodynamics measurement regularly. Special emphasis should be put when the blood flow volume is <800 mL/min on ultrasound in order to avoid AVF dysfunction.

导出引用

丁红;顾奇澜;朱宇莉;周志英;白寿军. 高频超声监测稳定血透患者动静脉内瘘并发症的临床价值再评价[J]. 中国临床医学影像杂志. 2015, 26(2): 118-121

DING Hong;GU Qi-lan;ZHU Yu-li;ZHOU Zhi-ying;BAI Shou-jun. Monitoring vascular complications on autogenous arteriovenous fistulas in hemodialysis patients: value of high-frequency ultrasound[J]. Journal of China Clinic Medical Imaging. 2015, 26(2): 118-121

中图分类号： Ｒ692.5 Ｒ445.1