糖尿病肾病病人自体动静脉内瘘血流动力学改变的研究  

Study on hemodynamic changes of autologous arteriovenous fistula in patients with diabetic nephropathy

作　　者：宋利[1] 符霞[1] 田秀兰[1] 赵立艳[1] 杨珠英[1] 钟咪[1] 全梓林[1] 叶智明[1] 

机构地区：[1]广东省医学科学院广东省人民医院

出　　处：《护理研究（上旬版）》2017年第5期1579-1583,共5页Chinese Nursing Researsh

基　　金：广东省省级科技计划项目;编号:2015A020210071

摘　　要：[目的]探讨糖尿病肾病与非糖尿病肾病病人自体动静脉内瘘在血流动力学方面是否有差异。[方法]采用横断面调查研究设计,自2016年7月—8月对采用自体动静脉内瘘为血管通路的139例维持性血液透析病人进行彩色多普勒超声检查,采用二维超声模式顺序探查内瘘吻合桡动脉近心端1cm处及吻合静脉距吻合口1cm、5cm、10cm处的血管内径、皮下深度,同时测量穿刺部位血管是否存在狭窄或闭塞等。[结果]糖尿病组吻合口内径、吻合动脉近心端内径、吻合静脉距吻合口1cm、5cm处的血管内径及吻合动脉近心端血流量显著低于非糖尿病组,差异有统计学意义(P<0.05);不同性别中糖尿病组吻合动脉近心端内径均显著小于非糖尿病组(P<0.05或P<0.01);选择绳梯式穿刺的糖尿病组吻合口内径和吻合动脉近心端内径均显著低于非糖尿病组(P<0.05或P<0.01);年龄<65岁的糖尿病组吻合口内径和吻合动脉近心端内径均显著低于非糖尿病组(P<0.05或P<0.01)。[结论]糖尿病肾病病人动静脉内瘘在血流动力学方面与非糖尿病病人存在差异。在血管通路维护和监测方面,需要加强糖尿病肾病病人内瘘吻合口内径和吻合动脉近心端内径和血流动力学变化监测,关注穿刺部位血管内径及狭窄程度,特别对扣眼穿刺的透析病人。Objective：To explore the hemodynamic changes of autologous arteriovenous fistula in patients with or without diabetic nephropathy.Methods：A cross-sectional survey research design was used in this study.A total of 139 patients with maintenance hemodialysis who underwent autologous arteriovenous fistula as vessel access received color Doppler ultrasonic inspection from July to August in 2016.The two-dimensional ultrasound model was used to probe the vascular diameter and subcutaneous depth at 1 cm from fistula proximal anastomosis radial artery,1 cm,5 cm,and 10 cm from anastomotic venous to the anastomotic stoma.The blood vessel in puncture site had stenosis or occlusion or not at the same time.Results：The diameter of the anastomotic stoma,proximal anastomosis artery,at 1 cm and 5 cm from anastomotic vein to the anastomotic stoma and the blood flow of proximal anastomosis artery were significantly lower than those in the non-diabetic group,and the difference was statistically significant （P〈0.05）.The diameter of proximal anastomosis artery in patients with different genders in diabetic group was lower than that in non-diabetic group （P〈0.05 or P〈0.01）.The diameter of the anastomotic stoma and the proximal anastomosis artery in patients with rope ladder puncture in the diabetic group were significantly smaller than those in the non-diabetic group （P〈0.05 or P〈0.01）.The diameter of the anastomotic stoma and the proximal anastomosis artery in patients over 65 years old in the diabetic group were smaller than those in non-diabetic group （P〈0.05 or P〈0.01）.Conclusion：There were differences in hemodynamic aspect of the autologous arteriovenous fistula between patients with or without diabetic nephropathy.In the vascular access maintenance and monitoring,medical staff should strengthen the monitoring of diameter of the anastomotic stoma and the proximal anastomosis artery and hemodynamic changes in patients with diabetic nephropathy,pay more attention to the vascular diameter in punct

关 键 词：动静脉内瘘 血液透析 扣眼穿刺 糖尿病肾病 血流动力学 超声检查 

分 类 号：R473.5[医药卫生—护理学]