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朱苓瑕.术前血管B超对细径血管血液透析患者建立动静脉内瘘有益[J].内科急危重症杂志,2026,32(1):66-69
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| DOI：10.11768/nkjwzzzz20260115 |
| 中文关键词: 血液透析 动静脉内瘘 细径血管 B超 血管直径 成功率 |
| 英文关键词: |
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| 摘要点击次数: 61 |
| 全文下载次数: 60 |
| 中文摘要: |
| 摘要 目的：探析术前B超检查血管直径对维持性血液透析（MHD）患者建立自体动静脉内瘘成功的影响。方法：选择动静脉直径＜2 mm的90例MHD患者进行前瞻性研究，根据血管直径分为A 组（＜1.0 mm）、B 组（1.0~<1.5 mm）、C 组（1.5~<2.0 mm）各30例。均接受围术期B超检测，之后完成腕部头静脉-桡动脉端侧吻合术。比较不同细径血管直径患者临床特征，统计术后6周动静脉内瘘成功率；比较动静脉内瘘成功组、失败组临床特征； Logistic回归分析细径血管建立动静脉内瘘成功的影响因素。结果：A、B、C 组患者性别、年龄、原发病、建瘘侧、静脉距皮距离、动脉钙化、动脉粥样斑块、吻合口直径资料比较，差异无统计学意义（P均＞0.05），而3组平均动脉压、静脉内径扩张性、肱动脉血流量比较，差异有统计学意义（P均<0.05），且血管直径越大，平均动脉压、静脉内径扩张性、肱动脉血流量越高。3组动静脉内瘘成功率比较，差异有统计学意义（P<0.05），且血管直径越大，动静脉内瘘成功率越高。术后6周随访，成功组77例（85.56%），失败组13例。成功组、失败组患者性别、年龄、原发病、建瘘侧、平均动脉压、静脉距皮距离、吻合口直径资料比较，差异无统计学意义（P均＞0.05），而2组动静脉管径、静脉内径扩张性、动脉钙化、肱动脉血流量、动脉粥样斑块比较，差异有统计学意义（P均<0.05），经Logistic回归分析显示，动静脉管径（1.0~<1.5 mm、1.5~<2.0 mm）、静脉内径扩张性≥0.6 mm、无动脉钙化、肱动脉血流量≥150 mL/min、无动脉粥样斑块均为细径血管建立动静脉内瘘成功的独立影响因素（P均＜0.05）。结论：术前B超检查血管直径对提高细径血管MHD患者动静脉内瘘成功率有临床意义。 |
| 英文摘要: |
| Abstract Objective: To investigate the impact of preoperative B-ultrasound measurement of vessel diameter on the success rate of establishing autologous arteriovenous fistulas (AVFs) in patients undergoing maintenance hemodialysis (MHD) with small-diameter vessels. Methods: A prospective study was conducted on 90 MHD patients with arteriovenous diameters <2 mm. Patients were divided into three groups based on vessel diameter: group A (<1.0 mm), group B (1.0-<1.5 mm), and group C (1.5-<2.0 mm), with 30 patients in each group. All patients underwent perioperative B-ultrasound examinations, followed by wrist cephalic vein-radial artery end-to-side anastomosis. Clinical characteristics were compared among patients with different vessel diameters, and the success rate of AVFs was statistically analyzed at 6th week postoperatively. Clinical characteristics were compared between the successful and failed AVF groups, and logistic regression analysis was performed to identify factors influencing the success of AVF establishment in patients with small-diameter vessels. Results: No significant differences were observed among groups A, B, and C in terms of gender, age, primary disease, fistula-building side, vein-to-skin distance, arterial calcification, atherosclerotic plaques, or anastomotic diameter (all P> 0.05). However, significant differences were found in mean arterial pressure, venous distensibility, and brachial artery blood flow among the three groups (all P< 0.05), with higher values corresponding to larger vessel diameters. The success rate of AVFs differed significantly among the three groups (P< 0.05), with higher success rates associated with larger vessel diameters. At the 6-week postoperative follow-up, 77 cases (85.56%) were successful, and 13 cases failed. No significant differences were observed between the successful and failed groups in terms of gender, age, primary disease, fistula-building side, mean arterial pressure, vein-to-skin distance, or anastomotic diameter (all P> 0.05). However, significant differences were found in arteriovenous diameter, venous distensibility, arterial calcification, brachial artery blood flow, and atherosclerotic plaques between the two groups (all P< 0.05). Logistic regression analysis revealed that arteriovenous diameter (1.0-<1.5 mm, 1.5-<2.0 mm), venous distensibility ≥0.6 mm, absence of arterial calcification, brachial artery blood flow ≥150 mL/min, and absence of atherosclerotic plaques were independent factors influencing the success of AVF establishment in patients with small-diameter vessels (all P< 0.05). Conclusion: Preoperative B-ultrasound measurement of vessel diameter is clinically significant for improving the success rate of AVF establishment in MHD patients with small-diameter vessels. |
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