术后常规彩色多普勒超声监测在发现动静脉内瘘狭窄中的临床意义探讨  

The value of selective versus routine postoperative duplex ultrasound imaging for the evaluation of stenosis after arteriovenous fistula surgery

作　　者：梁玉枫[1] 陈勇平[1] 黄彬三 丘美兰 蓝梅金 廖伟增[1] 梁兴澜 Liang Yufeng;Chen Yongping;Huang Binsan(The Second Hospital of Longyan City,Longyan,Fujian 36400)

机构地区：[1]龙岩市第二医院,福建龙岩364000

出　　处：《基层医学论坛》2018年第29期4076-4079,共4页The Medical Forum

基　　金：龙岩市科技计划项目(2016LY65)

摘　　要：目的探讨尿毒症患者行自体动静脉内瘘(arteriovenous fistulas,AVF)术后常规彩色多普勒超声监测在发现动静脉内瘘狭窄中的临床意义。方法选择2016年1月—2018年1月收治的92例拟行AVF手术的患者为常规组,同时收集2014年1月—2015年12月在我院规律透析的患者106例组为选择组,分别予以常规彩色多普勒超声监测及选择性彩色多普勒超声监测。分析2组患者术后随访期间内瘘狭窄的发生率、狭窄严重程度。结果常规组92例患者中发生内瘘狭窄10例,发生率为10.9%,选择组发生内瘘狭窄23例,发生率为21.7%,差异具有统计学意义(P<0.05);常规组血栓形成3例,选择组血栓形成共11例,差异具有统计学意义(P<0.05)。常规组狭窄的15例患者中,其中狭窄发生于静脉段、动脉段、吻合口分别为11,2,2例,发生狭窄的血管内径、流速与无并发症组相比,差异具有统计学意义(P<0.05)。结论 AVF术后常规行彩色多普勒超声监测有利于早期诊断动静脉内瘘狭窄,同时能够量化狭窄的程度,为临床提供是否需要早期干预的可靠依据。Objective To investigate routine deplex ultrasound examinations for detection of stenosis in arteriovenous fistula（AVF）in hemodialysis patients. Methods A total of 96 hemodialysis patients with AVF and treated in the Hemodialysis Center during the period from Jan. 2016 to Jan.2018 were enrolled into routine duplex ultrasonography（routine group）and 106 patients treated during Jan. 2014 to Dec. 2015 were assessed to selective duplex ultrasonography（selective group）. AVF stenosis rate,stenosis degree within the two years after AVF surgery were analyzed. Results AVF stenosis was found in 10 cases（10.9%）in routine group（n=92）,and in 23 cases（21.7%）in selective group（n=102）（χ~2 =4.158 P=0.04）. AVF thrombosis in AVF were found in3 cases in routine group,and in 11 cases respectively in selective group（χ~2=3.796,P=0.05）. There was also statistically significant difference in the diameter of stenostic vessels and vascular blood flow between the stenosis group and no complication（P〈0.05）.Conclusion Routine preoperative ultrasound vessel imaging significantly detect AVF stenosis and its location and range in hemodialysis patients,useful for the early intervention of AVF stenosis and the extension of AVF life.

关 键 词：尿毒症 动静脉内瘘 狭窄 彩色多普勒超声 常规监测 

分 类 号：R445.1[医药卫生—影像医学与核医学] R692.5[医药卫生—诊断学]