动静脉内瘘超声参数与内瘘功能不良的相关性研究

摘要

目的:分析维持性血液透析(MHD)患者动静脉内瘘(AVF)的超声参数特征及其与AVF功能不良之问的关系. 方法:采集以AVF为透析通路的MHD患者临床信息,于非透析日行超声检查,监测血流动力学参数及评估AVF并发症情况. 结果:将患者按内瘘功能分为功能良好组(115例)和功能不良组(29例),两组平均肱动脉流量分别为1 150.62±63.6 ml/min及803.84± 108.91 ml/min(P＜0.05),桡动脉流量分别为765.82±34.97ml/min及478.57±67.36 ml/min(P＜0.01),肱动脉阻力指数(RI)分别为0.48±0.01及0.55±0.03(P＜0.01),桡动脉RI分别为0.35±0.01及0.39±0.02(P＜0.05),将肱动脉和桡动脉的RI、流量、瘘口直径分别按四分位法进行分组,统计各组内瘘功能不良发生率,发现当肱动脉流量＜641.3 ml/min、桡动脉流量＜428.3 ml/min、桡动脉RI＞0.41、瘘口直径＜0.39 cm时,AVF功能不良发生率显著升高. 结论:本研究证实AVF超声参数与其功能之间具有良好的相关性,内瘘超声检查可为AVF功能不良早期实施干预措施提供依据和参考.%Objective:To reveal the relationship between doppler parameters and AVF dysfunction.Methodology:Doppler Uhrasonography(DU) was used to examine the AVF in MHD patients on the interval day.Monitoring indexes:blood flow,pulsatility index(PI),resistance index(RI),anastomosis diameter.Results:According to the function of AVF,patients were divided into well-functional group (115 cases) and dysfunctional group (29 cases).The blood flow volume and anastomosis diameter showed a significant reduction in dysfunctional group compared with well-functional group (803.84±108.91 ml/min vs 1 150.62±63.6 ml/min and 0.47±0.02 cm vs 0.37±0.03 cm,respectively,P＜0.05),the RI showed a significant increase in dysfunctional group compared with well-functional group (0.55 ± 0.03 vs 0.48± 0.01,P＜ 0.01),We further grouped patients according to the quarterback of blood flow,RI,anastomosis diameter and analyzed the incidence of fistula dysfunction within each group.Finally,we found out that the incidence of fistula dysfunction increased significantly when the blood flow volume ＜ 641.3 ml/min,the RI＞ 0.41 and the anastomosis diameter ＜ 0.39 cm.Conclusion:This study confirmed that the AVF ultrasonic parameters and AVF dysfunction has good correlation.The DU examination could provide basis and references for AVF dysfunction early intervention.