肾功能衰竭患者动—静脉造瘘术后出现血液透析灌注不足的超声图像特征分析(1)
[摘要]目的 分析肾功能衰竭患者行动-静脉造瘘术后出现灌注不足情况的多普勒彩色超声图像的特征。方法 选择我院2010年1月～2016年5月收治的70例行动-静脉造瘘术后血液透析灌注不足的肾功能衰竭患者，对患者的桡动脉、静脉以及吻合口的彩色血流束、血流动力学参数、走形以及内径等进行观察记录，并对狭窄血管的狭窄度进行计算。结果 70例患者中，49例(70.0%)患者有血栓形成；其中狭窄31例，完全闭塞18例；14例(20.0%)患者出现吻合口瘢痕收缩，其中高度狭窄8例，中度狭窄6例；4例(5.7%)患者出现局部血肿压迫，其中2例中度狭窄，2例闭塞；3例(4.3%)出现吻合口手术狭窄，且均为中度狭窄。结论 吻合口瘢痕收缩、血栓形成、局部的血肿压迫以及吻合口手术狭窄等是导致肾功能衰竭患者行动-静脉造瘘术后发生血液透析灌注不足的主要因素，而血管狭窄以及血管闭塞是导致灌注不足的血流动力学因素，多普勒彩超对于肾功能衰竭患者行动-静脉造瘘术后出现的血液透析灌注不足的监测具有重要的临床价值。
[关键词]肾功能衰竭；肾造瘘术；超声检查
[中图分类号] R445.1 [文献标识码] A [文章编号] 1674-4721(2016)07(a)-0137-03
[Abstract]Objective To analyze the color Doppler ultrasound images feature of renal failure (RF) patients with hemodialysis hypoperfusion after renal fistulation. Methods 70 patients with RF with hemodialysis hypoperfusion after renal fistulation treated in our hospital from January 2010 to May 2016 were chosen.The characteristics of blood flow of cephalic vein，radial artery and anastomotic stoma，hemodynamic parameters，shape and diameter were observed in patients with RF.In addition，the degree of vessel stenosis was also measured.Results 49 cases (70.0%) were with thrombosis.of whom 31 cases had stenosis and 18 cases had completed occlusion；14 cases (20.0%) were with anastomotic scar contraction，of whom 8 cases had severe stenosis and 6 cases had moderate stenosis；4 cases (5.7%) were with local hematoma compression，of whom 2 cases had moderate stenosis and 2 cases had occlusion；3 cases (4.3%) were with anastomotic operative stenosis in moderate degree.Conclusion Anastomotic scar contraction，thrombosis，local hematoma compression and anastomotic operative stenosis etc. are the main reasons causing hemodialysis hypoperfusion after fistulation in patients with RF.Vascular occlusion and stenosis are the causes of hemodynamic hypoperfusion.The color Doppler ultrasound has important clinical value in monitoring hemodialysis hypoperfusion after renal fistulation.
[Key words]Renal failure；Renal fistulation；Ultrasonic examination
终末期的肾功能衰竭患者的肾脏由于长期经受各种肾脏疾病的病理改变，使肾小球发展成为纤维硬化的无功能肾小球，并且相应的肾小管也发生萎缩后丧失其功能，对于终末期的肾功能衰竭患者来说，血液透析是维持其生命的重要治疗方法[1-2]。目前动-静脉内瘘已经成为血液透析的首选通路，是肾功能衰竭患者重要的生存保障，但当患者出现血液透析灌注不足时，就会使患者体内的尿素氮等对机体有害的小分子毒素无法得到及时有效的清除，从而引起透析失败[3-4]。本研究选择我院行动-静脉造瘘术后出现的血液透析灌注不足的肾功能衰竭患者进行多普勒彩色超声检查，旨在对导致患者出现血液透析灌注不足的因素进行分析，为临床提供指导。
1资料与方法
1.1一般资料
选择我院2010年1月～2016年5月收治的70例行动-静脉造瘘术后血液透析灌注不足的肾功能衰竭患者，其中男性36例，女性34例；年龄47～71岁，平均(59.1±9.7)岁，所有患者的诊断均符合文献标准。患者采用桡动脉侧和前臂头静脉端吻合的手术方式，吻合后患者出现血液透析灌注不足情况，时间为术后8 h～49个月。 (谢础能 陈湘华 王碧飞)
[关键词]肾功能衰竭；肾造瘘术；超声检查
[中图分类号] R445.1 [文献标识码] A [文章编号] 1674-4721(2016)07(a)-0137-03
[Abstract]Objective To analyze the color Doppler ultrasound images feature of renal failure (RF) patients with hemodialysis hypoperfusion after renal fistulation. Methods 70 patients with RF with hemodialysis hypoperfusion after renal fistulation treated in our hospital from January 2010 to May 2016 were chosen.The characteristics of blood flow of cephalic vein，radial artery and anastomotic stoma，hemodynamic parameters，shape and diameter were observed in patients with RF.In addition，the degree of vessel stenosis was also measured.Results 49 cases (70.0%) were with thrombosis.of whom 31 cases had stenosis and 18 cases had completed occlusion；14 cases (20.0%) were with anastomotic scar contraction，of whom 8 cases had severe stenosis and 6 cases had moderate stenosis；4 cases (5.7%) were with local hematoma compression，of whom 2 cases had moderate stenosis and 2 cases had occlusion；3 cases (4.3%) were with anastomotic operative stenosis in moderate degree.Conclusion Anastomotic scar contraction，thrombosis，local hematoma compression and anastomotic operative stenosis etc. are the main reasons causing hemodialysis hypoperfusion after fistulation in patients with RF.Vascular occlusion and stenosis are the causes of hemodynamic hypoperfusion.The color Doppler ultrasound has important clinical value in monitoring hemodialysis hypoperfusion after renal fistulation.
[Key words]Renal failure；Renal fistulation；Ultrasonic examination
终末期的肾功能衰竭患者的肾脏由于长期经受各种肾脏疾病的病理改变，使肾小球发展成为纤维硬化的无功能肾小球，并且相应的肾小管也发生萎缩后丧失其功能，对于终末期的肾功能衰竭患者来说，血液透析是维持其生命的重要治疗方法[1-2]。目前动-静脉内瘘已经成为血液透析的首选通路，是肾功能衰竭患者重要的生存保障，但当患者出现血液透析灌注不足时，就会使患者体内的尿素氮等对机体有害的小分子毒素无法得到及时有效的清除，从而引起透析失败[3-4]。本研究选择我院行动-静脉造瘘术后出现的血液透析灌注不足的肾功能衰竭患者进行多普勒彩色超声检查，旨在对导致患者出现血液透析灌注不足的因素进行分析，为临床提供指导。
1资料与方法
1.1一般资料
选择我院2010年1月～2016年5月收治的70例行动-静脉造瘘术后血液透析灌注不足的肾功能衰竭患者，其中男性36例，女性34例；年龄47～71岁，平均(59.1±9.7)岁，所有患者的诊断均符合文献标准。患者采用桡动脉侧和前臂头静脉端吻合的手术方式，吻合后患者出现血液透析灌注不足情况，时间为术后8 h～49个月。 (谢础能 陈湘华 王碧飞)