彩色多普勒超声对血液透析患者血管通路病变检测及并发症预防应用价值研究  

Study on the value of color Doppler ultrasound in detecting vascular pathologic changes and preventing complications in hemodialysis patients

作　　者：王雪 金壮 蒋南 鲁超 董佳 WANG Xue;JIN Zhuang;JIANG Nan;LU Chao;DONG Jia(Department of Ultrasonic Diagnosis,General Hospital of Northern Theater Command,Shenyang 110016,China;Department of Military Clinic,General Hospital of Northern Theater Command,Shenyang 110016,China)

机构地区：[1]北部战区总医院超声诊断科,辽宁沈阳110016 [2]北部战区总医院军人门诊,辽宁沈阳110016

出　　处：《临床军医杂志》2025年第2期140-143,共4页Clinical Journal of Medical Officers

基　　金：辽宁省科学技术计划(2020JH2/10300122)。

摘　　要：目的探讨彩色多普勒超声(CDU)对血液透析患者血管通路病变检测及并发症预防的应用价值。方法选取北部战区总医院自2021年1月至2024年6月收治的接受维持血液透析治疗的108例患者为研究对象。在CDU检查后评估患者桡动脉-头静脉动静脉内瘘成形术的成熟状况及并发症发生情况。结果与术前比较,患者造瘘术后2、4、6周时的桡动脉管径、桡动脉血流量、头静脉管径均增大,差异有统计学意义(P<0.05)。头静脉血流量随着术后时间延长而逐步增大,相邻两个时间点比较,差异均有统计学意义(P<0.05)。108例患者中,69例血流通畅,39例发生并发症(其中,19例血栓形成,11例管腔狭窄,9例静脉瘤状扩张)。与血流通畅组比较,血栓形成组、管腔狭窄组患者的桡动脉血管内径均减小(P<0.05);血栓形成组、管腔狭窄组、静脉瘤状扩张组患者的桡动脉收缩期峰值流速均减小,但吻合口收缩期峰值流速均增大(P<0.05);血栓形成组、管腔狭窄组患者的桡动脉阻力指数均增大,但静脉瘤状扩张组患者的桡动脉阻力指数减小(P<0.05)。与吻合口血管内径比较,血流通畅组、血栓形成组、管腔狭窄组、静脉瘤状扩张组患者的桡动脉血管内径、头静脉血管内径均增大(P<0.05)。结论CDU是血液透析患者血管通路病变检测及并发症预防的重要工具。Objective To investigate the application value of color Doppler ultrasound(CDU)in the detection of vascular access lesions and the prevention of complications in hemodialysis patients.Methods A total of 108 patients receiving maintenance hemodialysis from January 2021 to June 2024 in General Hospital of Northern Theater Command were selected as the study objects.The maturity and complications of radial arteriovenous fistula were evaluated after CDU examination.Results Compared with the preoperative results,the radial artery diameter,radial artery blood flow and cephalic vein diameter of the patients at 2,4 and 6 weeks after fistula operation were increased,with statistical significance(P<0.05).The head venous blood flow increased gradually with the extension of postoperative time,and the differences were statistically significant(P<0.05).Of the 108 patients,69 had unobstructed blood flow and 39 had complications(19 thrombosis,11 lumen stenosis and 9 venomatous dilatation).Compared with the unobstructed blood flow group,the internal diameter of the radial artery in the thrombosis group and the lumen stenosis group decreased(P<0.05).The peak radial systolic flow velocity decreased in the thrombosis group,lumen stenosis group and venomatous dilatation group,but increased in the anastomotic systolic peak flow velocity(P<0.05).The radial artery resistance index increased in both the thrombosis group and the lumen stenosis group,but decreased in the venomatous dilatation group(P<0.05).Compared with the inner diameter of anastomotic vessel,the inner diameter of radial artery and cephalic vein were increased in patients with unobstructed blood flow,thrombosis,lumen stenosis and venomatous dilatation(P<0.05).Conclusion CDU is an important tool for detecting vascular pathologic changes and preventing complications in hemodialysis patients.

关 键 词：彩色多普勒超声 血液透析 血管通路 并发症 预防 

分 类 号：R445.1[医药卫生—影像医学与核医学]