彩色多普勒超声在血液透析患者动静脉内瘘并发症防治中的价值  

Value of color Doppler ultrasound in prevention of vascular complications on arteriovenous fistulas in patients with hemodialysis

作　　者：苑欣 菅梅[1] 陈琼[1] YUAN Xin;JIAN Mei;CHEN Qiong(Department of Ultrasound,Bayannur Hospital,Bayannur 015000,China)

机构地区：[1]巴彦淖尔市医院超声科,内蒙古巴彦淖尔015000

出　　处：《中国医学影像技术》2018年第10期1490-1493,共4页Chinese Journal of Medical Imaging Technology

摘　　要：目的探讨彩色多普勒超声在稳定血液透析患者自体动静脉瘘(AVF)并发症防治中的价值。方法对101例血液透析患者的AVF行超声检查,以二维超声观察桡动脉、头静脉及吻合口有无扩张及狭窄,管腔内有无血栓、斑块,血管周围有无血肿等情况;以多普勒超声观察血管内血流方向、血流充盈及血流速度。结果 31例AVF可见不同类型并发症,其中并发头静脉血栓13例(13/31,41.93%),并发头静脉管腔狭窄7例(7/31,22.58%),并发头静脉瘤样扩张4例(4/31,12.90%),并发桡动脉硬化3例(3/31,9.68%),并发造瘘口旁血肿3例(3/31,9.68%),并发假性动脉瘤1例(1/31,3.23%)。13例AVF无法挽救而放弃;18例接受治疗,之后14例AVF并发症明显改善,4例因效果不佳而放弃原AVF通路;其中AVF并发头静脉单纯血栓治疗有效率为76.92%(10/13),AVF并发头静脉狭窄治疗有效率为14.28%(1/7),AVF并发内瘘血肿治疗有效率为100%(3/3)。结论稳定血液透析患者的AVF常伴并发症,应用彩色多普勒超声对造瘘血管进行常规监测可及时发现并发症,指导临床干预治疗。Objective To explore the value of color Doppler ultrasound in the prevention of complications of arteriovenous fistula(AVF)in patients with hemodialysis.Methods Totally 101 patients with hemodialysis underwent ultrasound examinations.The dilation or stenosis of radial artery,cephalic vein and anastomosis,thrombus and plaque in the lumen,and hematoma around the vessels were observed with two-dimensional ultrasound.The direction,filling and velocity of blood flow were observed with Doppler ultrasound.Results Among 101 patients,31 patients were found with different types of AVF complications,including cephalic vein thrombosis in 13(13/31,41.94%),cephalic vein stenosis in 7(7/31,22.58%),cephalic vein aneurysm expansion in 4(4/31,12.90%),radial artery atherosclerotic in 3(3/31,9.68%),hematoma in 3(3/31,9.68%)and pseudoaneurysm in 1 patient(1/31,3.23%).Clinical management of AVF was given up in 13 patients whose pathways could not be saved.In 18 patients underwent treatment,AVF complications were significantly improved after the treatment in 14 patients,while treatments in 4 patients were ineffective and the original AVF pathways had to be abandoned.The cure rate of the cephalic vein thrombosis was 76.92%(10/13),of the cephalic vein stenosis was 14.28%(1/7),and of the hematoma was 100%(3/3).Conclusion There were some vascular complications in clinically normal AVF patients.Color Doppler ultrasound can clearly show the location,pathway,lumen and blood flow dynamics of low blood flow of AVF in hemodialysis patients and detect the complications for clinical reference.

关 键 词：超声检查 多普勒 彩色 血液透析 动静脉瘘 

分 类 号：R692.5[医药卫生—泌尿科学] R445.1[医药卫生—外科学]