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彩色多普勒超声对长期透析动静脉内瘘并发症评估价值

作者:于登锋 袁志红

所属单位:河南省漯河市第三人民医院超声科 (河南 漯河 462000)

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摘要

目的 分析彩色多普勒超声对长期透析患者动静脉内瘘并发症中的应用价值。方法 纳入2015年2月-2016年3月我院 收治64例长期透析患者当做研究对象,均利用彩超多普勒超声进行动静脉内瘘瘘口、头静脉以及桡动脉解剖结构、 血流动力学的检测。结果 超声检测显示,64例长期透析患者中,有48例动静脉内瘘较为通畅,有6例形成血栓,5 例狭窄,3例假性动脉瘤,且窃血综合征与心衰各1例;血管狭窄者瘘口血流量、头静脉内径、吻合口内径以及桡动 脉内径均明显小于正常者(P<0.05),且其血流量依然可以达到250ml/min。结论 彩色多普勒超声可有效检测长 期透析患者自身动静脉内瘘血管具体通路情况,准确诊断各种内瘘并发症,同时找出低血流量原因,给患者的临床 治疗提供重要参考。

Objective To analyze the value of color Doppler ultrasound in evaluating complications of internal arteriovenous fistula in patients undergoing long-term dialysis. Methods 64 patients who underwent long-term dialysis in the hospital from February 2015 to March 2016 were selected as the subjects. The orificium fistulae of internal arteriovenous fistula, anatomical structures of cephalic vein and radial artery and hemodynamics were detected with color Doppler ultrasound. Results The ultrasonic detection showed that among 64 patients undergoing long-term dialysis, there were 48 cases with relatively unobstructed internal arteriovenous fistula, 6 cases with thrombosis, 5 cases with stenosis, 3 cases with false aneurysm, 1 case with steal syndrome and 1 case with heart failure. The blood flow volume of orificium fistulae, the inner diameters of cephalic vein, anastomotic stoma and radial artery in patients with vascular stenosis were significantly less / shorter than those in normal subjects (P<0.05), and the blood flow volume could reach 250ml/min. Conclusion Color Doppler ultrasound can effectively detect the specific condition of vascular pathway of internal arteriovenous fistula in patients undergoing long-term dialysis. It also can accurately diagnose complications of different internal arteriovenous fistulas and find out the reasons of low blood flow, which provides important references for the clinical treatment of patients.

【关键词】彩色多普勒超声;长期透析;动静脉内瘘;并发症

【中图分类号】R445.1;R543

【文献标识码】A

【DOI】10.3969/j.issn.1009-3257.2018.02.014

前言

对于终末期肾脏部位疾病患者,长期血 液透析常用血管通路就是自体动静脉内瘘 (artetiovenousfistula,AVF),AVF通畅性会对血液 透析进行情况产生直接影响。导致内瘘失功常见原因 为内瘘血栓产生与狭窄,长期血液透析患者面临较高 动静脉内瘘并发症发生风险。内瘘血栓产生与狭窄临 床评估金标准为血管造影,可是血管造影带有创伤 性,不适合用于常规检查以及随访观察。彩超能够对 内瘘血管进行无创评估,对动静脉内瘘并发症评估发 挥着巨大作用[1-2]。本文以64例长期透析患者当做研究对象,分析彩色多普勒超声对长期透析患者动静脉 内瘘并发症的应用价值,现作如下汇报。