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目的分析维持性血液透析患者动静脉造瘘的彩色多普勒超声表现特点。方法应用Philips IU22彩色多普勒超声诊断仪对48例于我院肾内科行血液透析的慢性肾功能衰竭患者的桡动脉、头静脉、造瘘口及其周围血管进行检查,观察造瘘血管的血流动力学情况,重点排查有无并发症存在。结果 36例患者动静脉内瘘通畅,其超声特点为桡动脉近心端血流速度加快、阻力指数降低,造瘘口远心端血流方向正常;头静脉内血流动脉化;造瘘口处血流为五彩镶嵌的彩色信号,可探及高速的涡流频谱。12例出现并发症,其中血栓形成4例,超声表现为接近瘘口的一侧头静脉管腔内透声差,可见实性回声填充;静脉瘤样扩张3例,超声表现为头静脉管径增宽呈瘤样扩张,管腔内呈低速涡流血流频谱;静脉狭窄3例,超声表现为造瘘口处管腔明显变小,血流束明显变窄,该处可探及异常高速的湍流血流频谱;局部血肿形成1例,超声表现为动静脉造瘘口附近可见以无回声为主的混合回声区,形态不规则,其内无明显血流信号;感染1例,超声表现为动静脉造瘘周围组织增厚,回声稍增强,分布不均匀。结论维持性血液透析患者动静脉造瘘的彩色多普勒超声表现具有自身特点,可为临床的诊断及治疗提供科学依据。
Objective To analyze the color Doppler sonographic features of maintenance hemodialysis patients. Methods Forty-eight patients with chronic renal failure who underwent hemodialysis in our hospital were examined by Philips IU22 color Doppler sonography. The radial artery, the head vein, the ostomy opening and the surrounding blood vessels were examined. Hemodynamics, focusing on the investigation of the existence of complications. Results Thirty-six patients had unobstructed arteriovenous fistula. The ultrasonographic features were that the radial velocity of the proximal radial artery was increased, the resistance index decreased, the direction of telecentric flow in the fistula was normal, the arterial blood flow in the cephalic vein, The blood flow is multicolored mosaic color signal, can explore and high-speed vortex spectrum. Complications were found in 12 cases, of which thrombosis occurred in 4 cases. Ultrasonography showed poor sound transmission through the lumen of the cephalic vein close to the fistula. Real aneurysm was found in 3 cases. Widened tumor-like expansion, the lumen was low-velocity vortex flow spectrum; venous stenosis in 3 cases, the performance of the fistula lumen was significantly smaller, the blood flow significantly narrowed, where exploration and abnormal high-speed Turbulent blood flow spectrum; local hematoma formation in 1 case, ultrasound showed arteriovenous fistula near the echo-free mixed echo area, irregular shape, there was no significant blood flow signal; infection in 1 case, the performance of ultrasound Arteriovenous ostomy tissue thickening, slightly enhanced echogenicity, uneven distribution. Conclusions Color Doppler sonography of arteriovenous fistula in patients with maintenance hemodialysis has its own characteristics, which may provide a scientific basis for clinical diagnosis and treatment.