彩超监测24例毒症患者动静脉内瘘的回顾性研究.docVIP

彩超监测24例尿毒症患者动静脉内瘘的回顾性研究 佘亚鹏 赵新民 摘要 目的: 监测尿毒症患者动静脉内瘘术后一年血管通道的变化情况。方法: 24例尿毒症患者，AVF 术后2周及1年分别行彩色多普勒超声检查，测量头静脉内径、桡动脉内径及内中膜厚度、瘘口直径、内瘘流量。结果：AVF 术后1年与术后2周比较：头静脉内径明显增宽，瘘口直径增宽，流量增大，桡动脉内中膜厚度增加(Ｐ0.05)，桡动脉内径缩小(Ｐ0.05)；结论：彩超监测尿毒症患者动静脉内瘘血管通道的状况和流量变化对于临床血液透析方案的选择及调整具有重要意义。 关键词：彩色多普勒超声 尿毒症 动静脉内瘘 Retrospective study of vascular access by color Doppler ultrasonography in uraemic patients with internal arteriovenous fistula SHE Yapeng Department of Clinical Ultrasound,Zhongyuan Oilfield General Hospital Aabstract Objective：Retrospective study of vascular access in uraemic patients with internal arteriovenous fistula (AVF) operations 1 year later. Methods：24 uraemic patients, the internal diameter of cephalic vein and radial artery and orificium fistulae were consecutively measured by color Doppler ultrasonography at two weeks and one year after AVF operations. The fluence of AVF and IMT of radial artery were also consecutively measured .Results：The patients one year after AVF operations compared with two weeks after AVF operations ,a increase in internal diameter of cephalic vein and orificium fistulae were observed(P0.05),The IMT of radial artery was significantly thicker(P0.05) , the fluence of AVF also increased(P0.05), In contrast, the internal diameter of radial artery was smaller (P 0.05).Conclusions：C olor Doppler ultrasonography has important clinical diadynamic value for the vascular access in uraemic patients after AVF operation. Keywords：color Doppler ultrasonography uraemia internal arteriovenous fistula 0 引言　　尿毒症是慢性肾功能衰竭的终末阶段。1 资料与方法 1.1 研究对象 2001年6月至2005年3月间已行桡动脉－头静脉内瘘术的28例终末期尿毒症患者，其检验学指标为：GFR＜25ml/min，血Bu＞21.42mmol/L，血Cr＞442umol/L，临床症状明显19例，女：9例，年龄:30～69岁，平均51岁。患者内瘘均为桡动脉－头静脉端端吻合。分别于术后两周(刀口愈合后)及术后一年进行检测，每次检测安排在透析前1～2天。28例患者中，4例分别因为死亡、内瘘血栓、肾移植、改做腹膜透析导致失访。其余病人每周在我院血液净化中心透析2～3次，每次4小时。患者透析充分，血压控制满意，无严重电解质及酸碱平衡紊乱，无明显并发症。 1.2 研究方法 采用ATL－HDI 5000 型彩色超声诊断仪，5～12 MHz 高频线阵探头。病人仰卧，被检侧手臂外展，手掌向上平伸，检查前臂手腕AVF 吻合口处，显示内瘘口，分别测量瘘口内径、头静脉内径、桡动脉内径、内中膜厚度( IMT)。彩色多普勒显示内瘘血流方向，将脉冲多普勒取