彩超血流量及血流动力学参数监测在稳定血液透析患者自体动静脉内瘘中的应用
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摘要
目的探讨并分析彩超血流量及血流动力学参数监测在稳定血透患者自体动静脉内瘘中的临床应用价值。方法选取2013年1月～2018年1月于我院接受血液透析的56例自体动静脉内瘘患者为研究对象,采用彩色多普勒超声(仪器型号:飞利浦iu Elite及EPIQ5)对患者桡动脉、头静脉以及吻合口结构、峰值流速和血管阻力指数(RI)进行检测,并测量患者肱动脉血流量参数。结果 56例自体动静脉内瘘患者桡动脉、头静脉血管内径与健侧肢体相比显著增加(t=12.730、7.931、4.319,P <0.05)。56例患者接受超声检查后,血管平均血流量为(1059±475)mL/min,超声检查结果提示34例患者动静脉内瘘结果正常,22例患者伴有不同程度的并发症,其中包括狭窄7例,静脉瘤状扩张6例,盗血现象4例,血栓3例以及假性动脉瘤2例。中血流量组患者与低血流量组患者、高血流量组患者并发症发生率分别为15.38%、64.29%和56.25%,中血流量组显著较低(χ~2=11.826,P <0.05)。各组在血流量参数、桡动脉(血管内径、PSV)、吻合口(血管内径、PSV、RI)上差异有统计学意义(P <0.05),在头静脉内径上仅狭窄组显著减少,假性动脉瘤组显著增大,在桡动脉RI上狭窄组显著增高,假性动脉瘤组显著降低(P <0.05)。结论对动静脉内瘘患者进行血流量和血液动力学检测可早期发现狭窄、假性动脉瘤等并发症,对于合并血流量参数较高和较低的患者应特别注意并发症的发生。
Objective To explore and analyze the application value of color ultrasound blood flow and hemodynamic parameters monitoring in autologous arteriovenous fistula of patients with stable hemodialysis. Methods Fifty-six patients with autologous arteriovenous fistula who underwent hemodialysis in our hospital from January 2013 to January 2018 were selected as subjects.Color Doppler ultrasound(instrument type:Philips iu Elite and EPIQ5)was used to detect the radial artery,cephalic vein,anastomotic structure,peak flow velocity and vascular resistance index(RI),and to measure the parameters of brachial artery blood flow. Results The diameters of radial artery and cephalic vein in 56 patients with autologous arteriovenous fistula were significantly increased compared with those of healthy limbs(t=12.730,7.931,4.319,P < 0.05).The mean blood flow of56 patients was(1059±475)mL/min after ultrasound examination.Ultrasound examination showed that 34 patients had normal results of arteriovenous fistula and 22 patients had complications of different degrees,included 7 cases of stenosis,6 cases of venous aneurysmal dilatation,4 cases of stealing phenomenon,3 cases of thrombosis and 2 cases of pseudoaneurysm.The incidence of complications was respectively 15.38%,64.29% and 56.25% in middle blood flow group,low blood flow group and high blood flow group,the middle blood flow group was significantly lower(χ~2=11.826,P < 0.05).There were significant differences in blood flow parameters,radial artery(vascular diameter,PSV),anastomotic stoma(vascular diameter,PSV,RI)among the groups(P < 0.05).The diameter of cephalic vein in stenosis group decreased significantly,the pseudoaneurysm group increased significantly,the radial artery RI in stenosis group increased significantly,and the pseudoaneurysm group decreased significantly(P < 0.05).Conclusion Complications such as stenosis and pseudoaneurysm can be detected early by blood flow and hemodynamics in patients with arteriovenous fistula.For patients with high or low blood flow parameters,special attention should be paid to the occurrence of complications.
Objective To explore and analyze the application value of color ultrasound blood flow and hemodynamic parameters monitoring in autologous arteriovenous fistula of patients with stable hemodialysis. Methods Fifty-six patients with autologous arteriovenous fistula who underwent hemodialysis in our hospital from January 2013 to January 2018 were selected as subjects.Color Doppler ultrasound(instrument type:Philips iu Elite and EPIQ5)was used to detect the radial artery,cephalic vein,anastomotic structure,peak flow velocity and vascular resistance index(RI),and to measure the parameters of brachial artery blood flow. Results The diameters of radial artery and cephalic vein in 56 patients with autologous arteriovenous fistula were significantly increased compared with those of healthy limbs(t=12.730,7.931,4.319,P < 0.05).The mean blood flow of56 patients was(1059±475)mL/min after ultrasound examination.Ultrasound examination showed that 34 patients had normal results of arteriovenous fistula and 22 patients had complications of different degrees,included 7 cases of stenosis,6 cases of venous aneurysmal dilatation,4 cases of stealing phenomenon,3 cases of thrombosis and 2 cases of pseudoaneurysm.The incidence of complications was respectively 15.38%,64.29% and 56.25% in middle blood flow group,low blood flow group and high blood flow group,the middle blood flow group was significantly lower(χ~2=11.826,P < 0.05).There were significant differences in blood flow parameters,radial artery(vascular diameter,PSV),anastomotic stoma(vascular diameter,PSV,RI)among the groups(P < 0.05).The diameter of cephalic vein in stenosis group decreased significantly,the pseudoaneurysm group increased significantly,the radial artery RI in stenosis group increased significantly,and the pseudoaneurysm group decreased significantly(P < 0.05).Conclusion Complications such as stenosis and pseudoaneurysm can be detected early by blood flow and hemodynamics in patients with arteriovenous fistula.For patients with high or low blood flow parameters,special attention should be paid to the occurrence of complications.
引文
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[11]Sun X,He Y,Ma Y,et al.A Single-Center Retrospective Analysis of the Efficacy of a New Balloon Catheter in Autogenous Arteriovenous Fistula Dysfunction Resistant to Conventional Balloon Angioplasty[J].Ann Vasc Surg,2018,48(6):79-88.
[12]李军,刘虹,朱笑萍,等.动静脉内瘘对血液透析患者血流动力学影响的动态观察[J].中国现代医学杂志,2003,13(15):32-33,36.
[13]王立华,姜埃利,魏芳.动静脉内瘘建立后的血流动力学变化[J].中华肾脏病杂志,2015,31(10):797-800.
[14]任树风,张丽红,刘音,等.自体动静脉内瘘局部血流动力学研究[J].临床肾脏病杂志,2014,14(8):471-474.
[15]朱宇莉,丁红,范培丽,等.彩超对维持性血透患者自体动静脉内瘘血流量及血流动力学的监测[J].中国超声医学杂志,2014,30(9):824-826.
[2]陈荣荣,俞燕.动静脉内瘘血管内膜增生的细胞和分子病理机制[J].肾脏病与透析肾移植杂志,2016,25(5):475-478,455.
[3]任红旗.血液透析患者动静脉内瘘与心血管系统并发症[J].肾脏病与透析肾移植杂志,2016,25(6):563-567.
[4]汤跃武,罗仪.动静脉内瘘血流量对维持性血液透析患者心功能的影响[J].中国老年学杂志,2016,36(16):4033-4034.
[5]缪鹏,谭正力,田然,等.人工血管动静脉内瘘透析疗效及长期随访研究[J].中华医学杂志,2017,97(6):468-470.
[6]赵颖,张丽娟,乔淑芳,等.动静脉内瘘对血液透析患者左心功能及血流动力学的影响[J].临床肾脏病杂志,2014,14(12):756-757.
[7]彭小梅,刘园园,吴潮清,等.维持性血液透析患者自体动静脉内瘘失功的危险因素研究[J].中国全科医学,2017,20(1):67-70.
[8]王立华,魏芳,陈海燕,等.不同血管通路选择对维持性血液透析患者心功能的影响及预后影响因素研究[J].中国全科医学,2016,19(30):3681-3684,3690.
[9]喻晓东.动静脉内瘘对血液透析患者血流动力学及左心功能的影响[J].海南医学,2009,20(3):10-11.
[10]Kamyar MM,Saeed Modaghegh MH,Kazemzadeh G.Limb complaints after autogenous arteriovenous fistula creation in chronic hemodialysis patients[J].Semin Vasc Surg,2016,29(4):172-177.
[11]Sun X,He Y,Ma Y,et al.A Single-Center Retrospective Analysis of the Efficacy of a New Balloon Catheter in Autogenous Arteriovenous Fistula Dysfunction Resistant to Conventional Balloon Angioplasty[J].Ann Vasc Surg,2018,48(6):79-88.
[12]李军,刘虹,朱笑萍,等.动静脉内瘘对血液透析患者血流动力学影响的动态观察[J].中国现代医学杂志,2003,13(15):32-33,36.
[13]王立华,姜埃利,魏芳.动静脉内瘘建立后的血流动力学变化[J].中华肾脏病杂志,2015,31(10):797-800.
[14]任树风,张丽红,刘音,等.自体动静脉内瘘局部血流动力学研究[J].临床肾脏病杂志,2014,14(8):471-474.
[15]朱宇莉,丁红,范培丽,等.彩超对维持性血透患者自体动静脉内瘘血流量及血流动力学的监测[J].中国超声医学杂志,2014,30(9):824-826.