上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

自体动静脉内瘘术后成熟度的评估

袁凯1,2，王鹏1,2，梁卫1,2   

  1. 上海交通大学 医学院 1.附属仁济医院南院血管外科， 上海 201112； 2.附属仁济医院血管外科， 上海 200127
  • 出版日期:2015-12-28 发布日期:2016-01-21
  • 通讯作者: 王鹏, 电子信箱: wangpeng@renji.com。
  • 作者简介:袁凯（1982—）， 男， 住院医师， 硕士; 电子信箱: 26091859@qq.com。

Evaluation of maturity of autologous arteriovenous fistula after surgery

YUAN Kai1,2, WANG Peng1,2, LIANG Wei1,2   

  1. 1.Department of Vascular Surgery, Renji Hospital South Campus, Shanghai Jiao Tong University School of Medicine, Shanghai 201112， China; 2.Department of Vascular Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
  • Online:2015-12-28 Published:2016-01-21

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摘要：

目的  通过彩色多普勒超声技术观察患者前臂腕部动静脉内瘘（AVF）建立后的血流动力学变化，对AVF术后成熟度进行评估。方法  前瞻性研究拟新建前臂自体头静脉-桡动脉端侧内瘘的慢性肾衰竭患者，采用彩色多普勒超声技术测量患者手术前及术后1、14、28和56 d桡动脉及头静脉直径、流量，头静脉内膜厚度及距皮肤深度，观察其变化趋势，评估自体AVF成熟度。结果  2014年5—9月共入组21例，其中男性12例，女性9例；平均年龄（54.3±13.2）岁，随访周期70 d，自体AVF均达到临床成熟标准。彩色多普勒超声检查结果显示：术后1、14 d时桡动脉及头静脉的直径和流量增幅最大（P<0.01），其后增幅放缓；术后28、56 d时差异无统计学意义（P>0.05)；术后28 d头静脉直径（5.0±1.0）mm，流量（1 593.7±572.9）mL/min；术后头静脉距皮肤深度的差异无统计学意义（P>0.05)。结论  AVF的成熟有赖于术前完善的血管评估。超声显示术后1个月，头静脉直径及流量已能满足穿刺血液透析的要求。头静脉内径> 4 mm且流量>500 mL/min可作为国人AVF成熟的标准，而最终标准的确立有待大样本的前瞻性研究。

关键词: 动静脉内瘘, 成熟度, 多普勒超声

Abstract:

Objective  To observe hemodynamic changes by color Doppler ultrasound technique after the construction of wrist arteriovenous fistula (AVF) and evaluate the maturity of AVF. Methods  The prospective study was carried out for patients with chronic renal failure who would undergo the construction of autologous wrist radiocephalic AVF. The internal diameters and blood flow of radial artery and cephalic vein, the intimal thickness of cephalic vein, and the depth of cephalic vein from the skin were measured by color Doppler ultrasound technique before and 1, 14, 28, and 56 d after surgery. The value change tendency was observed and maturity of AVF was assessed. Results  A total of 21 patients were enrolled from May 2014 to December 2014. Among them, 12 patients were male and 9 patients were female with ages of (54.3±13.2) years. Patients were followed up for 70 d and their autologous AVF all reached the clinical maturity criteria. Results of color Doppler ultrasound scan showed that internal diameters and blood flow of radial artery and cephalic vein 1 and 14 d after surgery increased most (P<0.01) and the increase slowed down afterwards. The differences of internal diameters and blood flow between 28 and 56 d after surgery were not statistically significant (P>0.05). The internal diameter and blood flow of cephalic vein 28 d after surgery were (5.0±1.0) mm and (1593.7±572.9) mL/min, respectively. The difference of the depth of cephalic vein from the skin after surgery was not statistically significant (P>0.05). Conclusion  The maturity of AVF is based on the perfect evaluation of radial artery and cephalic vein before surgery. The results of ultrasound scan have shown that the internal diameter and blood flow of cephalic vein 1 month after surgery can meet the requirements of hemodialysis. So for cephalic vein, the internal diameter >4 mm and blood flow >500 mL/min can be regarded as the maturity criteria of AVF for Chinese people. However, determination of the final criteria still needs prospective study based on large samples.

Key words: arteriovenous fistula, maturity, Doppler ultrasound