新建糖尿病肾病自体动静脉内瘘成熟度评估及血流动力学的研究  

Study on the maturation and hemodynamics of newly built autologous arteriovenous fistulas in diabetic nephropathy patients

作　　者：潘文静[1] 丁钟琴[1] 刘同强[1] 唐羽裳 PAN Wen-jing;DING Zhong-qin;LIU Tong-qiang;TANG Yu-chang(Blood Purification Center,the Second People's Hospital of Changzhou City,Jiangsu Province,Jiangsu 213000,China)

机构地区：[1]江苏省常州市第二人民医院血液净化中心,江苏213000

出　　处：《中国血液净化》2020年第5期330-333,共4页Chinese Journal of Blood Purification

摘　　要：目的探讨2型糖尿病肾病与非糖尿病肾病患者自体动静脉内瘘术后成熟度的差异,为透析治疗和护理提供参考依据。方法以2017年1月~2019年7月在常州市第二人民医院血液净化中心行自体动静脉内瘘手术的60例原发病为糖尿病肾病的患者为观察组,随机选取同时期60例非糖尿病肾病患者为对照组,术前术后由专业护理人员通过物理性检查并结合彩色多普勒超声评估2组内瘘成熟度,回顾性分析2组内瘘的成熟状态及血流动力学参数。结果①观察组内瘘成熟时,平均内瘘成熟时间为(88.25±7.30)d,头静脉平均内径为(4.85±1.31)mm,血流量为(586.49±78.33)ml/min,与对照组比较差异有统计学意义(t=-20.591,P<0.001;t=3.385,P=0.001;t=4.667,P<0.001)。②观察组术前桡动脉内径小于对照组,至成熟期时最终扩张程度也小于对照组,差异有统计学意义(t=2.224,P=0.029;t=-3.134,P=0.002)。对照组术后2周的头静脉内径和血流量接近成熟期的数值,观察组术后4周的头静脉内径和血流量才接近成熟期数值。结论糖尿病肾病患者自体动静脉内瘘术后成熟度及血流动力学与非糖尿病患者有差异,准确判断自体动静脉内瘘成熟状态,对于适时开展透析治疗、维持血液透析的顺利开展均有着重要意义。Objective To study the difference of the maturation of autologous arteriovenous fistula(AVF)between the patients with type 2 diabetic nephropathy and those with non-diabetic nephropathy,and to provide suggestions for dialysis treatment and nursing in these patients.Methods Sixty patients with diabetic nephropathy and treated in the period from January 2017 to July 2019 were recruited as the observation group,and 60 patients with non-diabetic nephropathy in the same period were randomly selected as the control group.Maturation of AVF and hemodynamic parameters of the patients in the two groups were examined by physical examination and color Doppler ultrasound and then analyzed retrospectively.Results①In observation group,the average maturation period of AVFs was 88.25±7.30 days,the average internal diameter of cephalic vein was 4.85±1.31 mm,and the average blood flow was 586.49±78.33 ml/min,significantly different from those in control group(t=-20.591,P<0.001 for maturation period;t=3.385,P=0.001 for cephalic vein diameter;t=4.667,P<0.001 for blood flow).②in observation group,the diameter of radial artery was smaller than that in control group before the surgery(t=2.224,P=0.029),and remained smaller after maturation(t=-3.134,P=0.002).The periods of internal diameter of cephalic vein and blood flow rate to the maturation values were 2 and 4 weeks in control group and observation group respectively.Conclusion The maturation and hemodynamics of AVF after the surgery are different between patients with diabetic nephropathy and those with non-diabetic nephropathy.These differences are of great significance in accurate determination of the AVF maturity,the time suitable for blood access,and successful performance of hemodialysis.

关 键 词：糖尿病肾病 动静脉内瘘 成熟度 血流动力学 彩色多普勒超声 

分 类 号：R318.16[医药卫生—生物医学工程]