自体动静脉内瘘触诊与血流量的对应关系分析  

The relationship between autologous arteriovenous fistula palpation and fistula flow rate

作　　者：徐元恺[1,2] 赵艺欣[2,3] 张文云[4] 段青青[2] 张丽红[2] XU Yuan-kai ZHAO Yi-xin ZHANG Wen-yun DUAN Qing-qing ZHANG Li-hong(Department of Nephrology, Zhejiang Hospital Department of Nephrology, The Third Hospital of Hebei Medical University Department of Nephrology, Naval general Hospital Ultrasound Department, The Third Hospital of Hebei Medical University)

机构地区：[1]浙江医院肾内科,浙江省杭州市310013 [2]河北医科大学第三医院肾内科,石家庄050051 [3]海军总医院肾内科,北京100048 [4]河北医科大学第三医院超声科,石家庄050051

出　　处：《中国血液净化》2016年第11期624-627,共4页Chinese Journal of Blood Purification

基　　金：河北省科技惠民计划项目(15277743D)

摘　　要：目的对正常使用的自体动静脉内瘘进行系统的物理检查,明确震颤的部位,并对内瘘进行超声监测,以期寻找正常内瘘触诊结果与动静脉内瘘功能之间的相关性。方法对自体动静脉内瘘进行全程触诊,对可触及明显震颤的最近心部位进行标定并记录,分为前臂中段、前臂近肘部、肘部及肘上4段;超声测量肱动脉、桡动脉及尺动脉的内径及流量,同时测量头静脉前臂中段,前臂近肘部及肘上的内径;依据物理检查结果分组并进行组间比较。结果 70例患者完成全部物理检查和超声检测。20例患者震颤仅达前臂中部及远端1/2;21例患者可达前臂上段1/2至肘部;18例患者可于肘部触及明显震颤;11例患者震颤可达肘上。前臂中段组、前臂近肘部组、肘部组及肘上组肱动脉平均内径分别为:(5.42±0.16)mm、(5.73±0.17)mm、(6.32±0.26)mm、(6.60±0.32)mm;4组间比较差异有统计学意义(F=5.553,P=0.002)。前臂中段组、前臂近肘部组、肘部组及肘上组肱动脉血流量分别为:543.00(382.50,626.00)ml/min、(748.62±66.79)ml/min、(924.06±69.57)ml/min、(1253.73±98.74)ml/min;4组间比较差异有统计学意义(F=12.407,P=0.000)。前臂中段组、前臂近肘部组、肘部组及肘上组肱动脉血流量的95%可信区间下限分别为432.91ml/min、609.30ml/min、777.28ml/min、1033.71ml/min。结论本研究通过对内瘘震颤的强度分级,发现震颤较强的内瘘具有更粗大的动脉血管管径及血流量,动脉系统的内径及流量随震颤强度的加强逐级递增。震颤强度对于内瘘动脉内径及血流量有一定程度的提示作用,肘部及以上触及明显震颤可以作为内瘘功能良好的标志之一。Object To analyze the relationship between the location of thrill due to autologous arteriovenous fistula （AVF） obtained by palpation and the flow rate in AVF measured by ultrasound. Methods Physical examination and Doppler ultrasound were used to examine the AVF in maintenance hemodialysis patients. Well-used wrist AVFs were included for the study. Palpation examination should cover all areas of the AVF. The most proximal site on which thrill was still perceptible was marked and divided into mid-forearm group, forearm near elbow group, elbow group, and upper arm group. Doppler ultrasound was used to examine the diameter and flow rate in brachial artery, radial artery, and ulnar artery. Diameters of the cephalic vein at mid- forearm, forearm near elbow, and upper arm were measured. Result Seventy patients were enrolled in this study. They were divided into mid-forearm group （n=20）, forearm near elbow group （n=21）, elbow group （tr= 18）, and upper arm group （n= 11） based on the most proximal site where thrill was still perceptible. In the mid- forearm group, forearm near elbow group, elbow group, and upper arm group, the average diameters of brachial artery were 5.42±0.16, 5.73±0.17, 6.32±0.26, and 6.60±0.32 mm respectively, significantly different among the 4 groups （F=5.553, P=0.002）; the average flow rates in brachial artery were 543 （382.5, 626）, 748.62±66.79, 924.06±69.57, and 1253.73±98.74ml/min respectively, significantly different among the 4 groups （F=- 12.407, P=0.000）; the 95% confidence interval of lower flow rate limits in brachial artery were 432.91, 609.30, 777.28, and 1033.71ml/min respectively. Conclusion Significant relationship was found between palpation of AVF and flow rate in AVF. Thrill palpated at more proximal site suggests the higher blood flow rate in AVF and a forearm fistula with thrill at elbow or upper arm can be viewed as a well-functional fistula.

关 键 词：自体动静脉内瘘 物理检查 内瘘触诊 血流量 

分 类 号：R318.16[医药卫生—生物医学工程]