彩超评测血液透析患者自体动静脉内瘘瘘口及血流速度的价值

doi:10.3760/cma.j.issn.1007-1245.2024.06.016

摘要/Abstract

摘要：

目的　研究彩超评测血液透析（HD）患者自体动静脉内瘘（AVF）瘘口及血流速度的价值。方法　选取2019年2月至2022年2月铜川市人民医院收治的150例HD患者进行前瞻性研究，其中男性87例，女性63例，年龄41～69（56.82±7.12）岁。对所有受试者均开展CT血管成像检查以及彩超检查，根据CT血管成像检查结果将患者分为狭窄组（内瘘狭窄）59例以及无狭窄组（内瘘正常）91例。比较两组肱动脉近分叉处（Qb）、瘘口近端桡动脉（Qr）、瘘口处（Qf）以及瘘口近端头静脉（Qc）的血流量。以受试者操作特征曲线（ROC）分析明确各项彩超参数评估HD患者AVF狭窄的效能，对比两组内瘘并发症发生情况。统计学方法采用t检验、χ²检验。结果　狭窄组Qb、Qr、Qf及Qc水平均低于无狭窄组［（377.45±103.46）ml/min比（491.52±136.71）ml/min、（320.58±102.99）ml/min比（410.89±138.46）ml/min、（476.12±112.57）ml/min比（566.43±129.85）ml/min、（519.04±120.87）ml/min比（667.36±134.53）ml/min］，差异均有统计学意义（t=5.47、4.30、4.38、6.86，均P<0.05）。经ROC分析发现，Qb评估血液透析患者AVF狭窄的曲线下面积为0.854，灵敏度、特异度分别为86.92%、84.10%，均高于Qr、Qf、Qc。狭窄组静脉侧狭窄、血栓形成、静脉瘤样扩张发生率均高于无狭窄组［23.73%（14/59）比6.59%（6/91）、20.34%（12/59）比4.40%（4/91）、37.29%（22/59）比17.58%（16/91）］，差异均有统计学意义（χ²=9.10、9.55、7.35，均P<0.05）。结论　彩超可有效评估HD患者AVF瘘口及血流速度，其中Qb在诊断HD患者AVF狭窄中的效能较佳，值得推广普及。

关键词:

血液透析, 彩色多普勒超声检查, CT血管成像, , , 血流速度, 自体动静脉内瘘

Abstract:

Objective　To study the value of color ultrasound in evaluating autologous arteriovenous fistula (AVF) orifice and blood flow velocity in hemodialysis (HD) patients. Methods　A total of 150 HD patients admitted to Tongchuan People's Hospital from February 2019 to February 2022 were included in the study. There were 87 males and 63 females, aged 41-69 (56.82±7.12) years. CT angiography and color ultrasound were performed in all subjects. According to the results of CT angiography, the patients were divided into a stenosis group (internal fistula stenosis, 59 cases) and a non-stenosis group (normal internal fistula, 91 cases). The blood flow at the proximal brachial artery (Qb), the proximal radial artery (Qr), the proximal fistula (Qf), and the proximal cephalic vein (Qc) of the two groups were compared. The receiver operating characteristic curve (ROC) was used to determine the effectiveness of color ultrasound parameters in the evaluation of autologous arteriovenous fistula stenosis in HD patients. In addition, the incidence of internal fistula complications was compared between the two groups. t test and χ² test were used. Results　The levels of Qb, Qr, Qf, and Qc in the stenosis group were lower than those in the non-stenosis group [(377.45±103.46) ml/min vs. (491.52±136.71) ml/min, (320.58±102.99) ml/min vs. (410.89±138.46) ml/min, (476.12±112.57) ml/min vs. (566.43±129.85) ml/min, (519.04±120.87) ml/min vs. (667.36±134.53) ml/min], with statistically significant differences (t=5.47, 4.30, 4.38, and 6.86, all P<0.05). ROC analysis showed that the area under the curve of Qb in evaluating autologous arteriovenous fistula stenosis in HD patients was 0.854, and the sensitivity and specificity were 86.92% and 84.10%, respectively, which were higher than those of Qr, Qf, and Qc. The incidences of venous stenosis, thrombosis, and phletomatous dilatation in the stenosis group were higher than those in the non-stenosis group [23.73% (14/59) vs. 6.59% (6/91), 20.34% (12/59) vs. 4.40% (4/91), 37.29% (22/59) vs. 17.58% (16/91)], with statistically significant differences (χ²=9.10, 9.55, and 7.35, all P<0.05). Conclusion　Color ultrasound can effectively evaluate AVF fistula and blood flow velocity in HD patients, and Qb has a best efficacy in diagnosing AVF stenosis in HD patients, which is worthy of popularization.

Key words:

Hemodialysis, Color Doppler ultrasound, CT angiography, Blood flow velocity, Autogenous arteriovenous fistula

高华武佳唯李新.

彩超评测血液透析患者自体动静脉内瘘瘘口及血流速度的价值 [J]. 国际医药卫生导报, 2024, 30(6): 957-962.

Gao Hua, Wu Jiawei, Li Xin.

Value of color ultrasound in evaluating the orifice of autologous arteriovenous fistula and blood flow velocity in hemodialysis patients [J]. International Medicine and Health Guidance News, 2024, 30(6): 957-962.

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注：箭头示扩张区域静脉管壁与主干静脉连续性良好，内、中、外膜结构清晰
图3　自体动静脉内瘘血液透析患者静脉瘤样扩张图
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