自体动静脉内瘘建立后的血管重构及其影响因素  

Characters and influential factors of vascular remolding after native arteriovenous fistula

作　　者：徐元恺[1] 张丽红[1] 张文云[2] 王自强[1] 林琼真[1] 王保兴[1] 李英[1] 

机构地区：[1]河北医科大学第三医院肾内科河北省肾脏病研究中心,石家庄050051 [2]河北医科大学第三医院超声科,石家庄050051

出　　处：《中华肾脏病杂志》2014年第6期424-428,共5页Chinese Journal of Nephrology

基　　金：河北省医学科学研究重点课题计划（20110110）

摘　　要：目的观察血液透析患者前臂腕部动静脉内瘘建立前后头静脉、肱动脉、桡动脉及尺动脉的血管内径变化，探讨内瘘建立后的血管重构特点及影响因素。方法选择2010年10月至2011年10月在河北医科大学第三医院接受腕部自体动静脉内瘘成形术患者为研究对象。应用彩色多普勒超声技术测量患者术前及术后1d、1周、2周、4周、8周时头静脉、肱动脉、桡动脉及尺动脉的血管内径，观察其变化趋势。结果28例患者平均年龄（53．68±2．61）岁。原发病为糖尿病肾病者12例。彩色多普勒超声检查结果显示：术后1d组各血管的扩张幅度最大，明显大于其余各时间段组，组间比较差异有统计学意义（均P〈0．01）。其余时间段组的血管内径变化率的组间比较差异无统计学意义（均P〉0．05）。依据患者原发病是否为糖尿病肾病分组后发现，两组患者的头静脉、肱动脉变化趋势差异无统计学意义（P〉0．05）；而桡动脉、尺动脉变化趋势的组间差异有统计学意义（均P〈0．01）。结论前臂自体动静脉内瘘建立后，头静脉、肱动脉、桡动脉及尺动脉均于术后1d发生明显扩张，内径迅速增大。此后上述血管内径扩张缓慢，逐步趋向稳定。原发病不同对桡动脉及尺动脉内径的变化趋势产生影响。Objective To finding out the characters of vascular remolding after the establishment of native arteriovenous fistula on the wrist, and exploring the influential factors. Methods Doppler ultrasound was used to monitor the diameter of cephalic vein, brachial artery, radial artery and ulnar artery at the time before the surgery and one day, one week, two weeks, four weeks and eight weeks after the surgery respectively. The tendency of the diameter change was analyzed. Results Twenty eight patients completed the whole monitor session, in which eleven were female. The average age of those patients was （53.68 ±2.61） years old. Twelve of them were diabetic nephropathy. The diameters of all vessel were increased more rapidly at the first day than any other days after surgery（all P 〈 0.01）. The patients were divided into two groups depending on whether diabetic nephropathy. No significant difference was found between the two groups on the tendency of diameter change in cephalic vein and brachial artery （all P 〉 0.05）. However, the tendency of diameter change in radial artery and ulnar artery was statistically significant difference between the two groups （all P 〈 0.05）. Conclusions Cephalic vein, brachial artery, radial artery and ulnar artery are all apparently dilated on the first day after the surgery. The vascular dilation and diameter increasing become much slower after the period, the diameter tend to be stable. The primary diseases may affect the tendency of the diameter change in radial artery as well as ulnar artery.

关 键 词：血液透析 血管通路 动静脉内瘘 血管重构 

分 类 号：R473.5[医药卫生—护理学]