Ultrasonographic monitoring of hemodynamics in patients with arteriovenous fistula and the value of evaluating the maturity of internal fistula
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摘要:
目的 分析彩色多普勒超声对评估动静脉内瘘(AVF)患者血流动力学和内瘘成熟程度的应用价值。 方法 回顾性选取2019年2月~2020年4月于本院首次进行动静脉内瘘手术的143例血液透析患者的临床资料。对所有患者行手术前后彩色多普勒超声检查，观察患者手术前后相关血流动力学指标及桡动脉和头静脉血流量、血管直径。术后6周，观察患者成熟情况并分析与头静脉血流动力学的关系。 结果 术后1、3、6周，患者的收缩期峰值流速、舒张期峰值流速均明显高于术前(P < 0.05)，阻力指数明显低于术前(P < 0.05)，桡动脉和头静脉的血流量和血管直径均明显大于术前(P < 0.05)；且术后1、3、6周患者的收缩期峰值流速、舒张期峰值流速及桡动脉和头静脉的血流量、血管直径比较，差异无统计学意义(P>0.05)，阻力指数在术后1、3、6相邻时间点均有统计学意义(P < 0.05)；术后6周，143例患者AVF成熟度为69.23%(99/143)，成熟组头静脉收缩期峰值流速、舒张期峰值流速、血管直径和血流量均明显大于未成熟组(P < 0.05)，阻力指数明显小于未成熟组(P < 0.05)；术后6周头静脉血流量预测AVF成熟的ROC曲线显示，ROC曲线下面积为0.938，预测AVF成熟的临界值为387.98 mL/min。 结论 彩色多普勒超声可通过反应相关血流动力学参数评估动静脉内瘘患者的内瘘成熟程度。 Abstract:Objective To analyze the value of ultrasound in evaluating hemodynamics and maturity of internal arteriovenous fistula (AVF). Methods The clinical data of 143 hemodialysis patients who underwent the first operation of venous fistula in our hospital from February 2019 to April 2020 were selected retrospectively. All patients were examined by color Doppler ultrasound before and after operation, and the related hemodynamic indexes, blood flow and diameter of radial artery and cephalic vein were observed before and after operation. Six weeks after operation, the maturity of the patients was observed and the relationship between Internal fistula maturity and Cephalic vein hemodynamics was analyzed. Results At 1 week, 3 weeks and 6 weeks after operation, the peak systolic velocity and diastolic peak velocity were significantly higher than those before operation, while the RI was significantly lower than that before operation(P < 0.05). The blood flow and diameter of radial artery and cephalic vein were significantly larger than those before operation(P < 0.05). There was no significant difference in peak systolic velocity, diastolic peak velocity, blood flow and diameter of radial artery and cephalic vein at 1 week, 3 weeks and 6 weeks after operation. Six weeks after operation, the maturity of AVF was 69.23%, peak systolic velocity, diastolic peak velocity, diameter and blood flow of cephalic vein in mature group were significantly higher than those in immature group(P < 0.05). RI was significantly lower than that in immature group(P < 0.05). ROC curve for predicting AVF maturity at 6 weeks after operation showed that the area under ROC curve was 0.938, and the critical value for predicting AVF maturity was 387.98 mL/min. Conclusion Color Doppler ultrasound can be used to evaluate the maturity of internal arteriovenous fistula in patients with arteriovenous fistula. -
Key words:
- ultrasound /
- arteriovenous fistula /
- hemodynamics /
- maturity of internal fistula /
- evaluation value
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图 1 内瘘术后多普勒超声影像
A: 瘘口狭窄; B: 瘘口狭窄处血流信号呈花色; C: 瘘口狭窄处呈高速动静脉谱; D: 流出道静脉内膜增生; E: 流出道静脉狭窄处血流信号呈花色; F: 流出道静脉狭窄处呈高速、低阻动脉化频谱; G：流出道静脉局部扩张；H：估测内瘘流量.
Figure 1. Doppler ultrasonography after operation of internal fistula
图 2 术后6周头静脉血流量预测AVF成熟的ROC曲线
Figure 2. ROC curve of cephalic venous blood flow predicting AVF maturity 6 weeks after operation.
表 1 143例患者手术前后血流动力学指标比较
Table 1. Comparison of hemodynamic indexes in 143 patients before and after operation(Mean±SD)
时间 PSV(cm/s) EDV(cm/s) RI值 术前 66.49±8.23 23.16±4.28 0.70±0.11 术后1周 138.15±13.26* 75.26±7.71* 0.51±0.13*# 术后3周 140.52±16.49* 77.39±7.09* 0.46±0.11*# 术后6周 142.73±11.05* 79.06±5.16* 0.36±0.08*# *P < 0.05 vs术前；#P < 0.05 vs组内相邻时间点；PSV收缩期峰值流速；EDV：舒张期峰值流速；RI：阻力指数. 
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表 2 143例患者手术前后桡动脉和头静脉血流量和血管直径比较
Table 2. Comparison of blood flow and diameter of radial artery and cephalic vein in 143 patients before and after operation(Mean±SD)
时间 桡动脉血流量(mL/min) 桡动脉血管直径(mm) 头静脉血流量(mL/min) 头静脉直径(mm) 术前 87.33±4.16 2.48±0.68 89.70±13.26 2.90±0.53 术后1周 759.16±65.46* 3.42±0.87* 159.19±10.33* 3.78±0.94* 术后3周 771.52±54.16* 3.54±0.96* 261.76±13.07* 3.97±0.85* 术后6周 783.63±69.17* 3.62±0.75* 264.11±14.42* 4.11±0.59* *P < 0.05 vs术前.
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表 3 143例患者AVF成熟情况与头静脉血流动力学的关系
Table 3. Relationship between AVF maturity and Cephalic vein hemodynamics in 143 patients(Mean±SD)
组別 PSV(cm/s) EDV(cm/s) RI值 血管直径(mm) 血流量(mL/min) 成数组(n=99) 166.15±9.21 94.16±8.72 0.31±0.05 4.08±0.59 461.16±67.49 未成熟组(n=44) 91.41±8.78 40.03±9.82 0.43±0.08 2.97±0.64 303.46±58.19 t 45.424 32.940 10.904 10.115 13.000 P < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
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