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目的 研究人体四肢动脉伤端端吻合术后血流动力学变化，为评价临床修复效果及近、远期疗效提供依据。方法 应用多谱勒超声仪对２１ 例患者的２７ 条端端吻合术后血管的通畅情况进行随访观察。应用受约束弹性管模型，在体测量流量波形，分析吻合血管的血流动力学特性。结果 术后早期２７ 条血管全部通畅，２１ 例患者中１５ 例获半年以上随访，血管均通畅。与健侧对照，术后每搏血流量（ＳＶ）下降，吻合口处血流平均速度（Ｖｍ）升高，壁面剪应力（τ） 下降，但各血管吻合口处与近、远端血管及健侧血管之间差异无显著性意义（ Ｐ ＞ ０．０５）。无论随访时间≤２４ 周或＞２４ 周的患者，其上、下肢血管吻合口处的Ｖｍ 均较健侧升高，ＳＶ 降低，τ下降，但差异无显著性意义（Ｐ ＞ ０．０５） 。两时间组的血流搏动指数（ＰＩ） 间差异无显著性意义（ Ｐ ＞ ０．０５）。随访时间≤２４ 周者，Ｖｍ 高于术后时间＞ ２４ 周者，ＳＶ 及τ均降低，但两时间组之间差异无显著性意义（ Ｐ ＞ ０．０５）。结论 血流动力学参数与血管壁面剪应力是辅助评价血管损伤吻合修复效果的良好参数指标，定期、连续观测有助于预测吻合修复血管的转归。
Objective To study the hemodynamic changes after end-to-end anastomosis of human limbs and limbs in order to provide a basis for evaluating the clinical effect and short-term and long-term efficacy. Methods Twenty-one patients with end-to-end anastomosis were examined with Doppler sonography. The constrained elastic tube model was used to measure the flow waveform in vivo and to analyze the hemodynamic characteristics of the anastomosed vessels. Results All the 27 vessels were smooth in the early postoperative period, and 15 of the 21 patients were followed up for more than half a year. All the vessels were smooth. Compared with the contralateral control group, the stroke volume (SV) decreased, the mean velocity (Vm) increased and the wall shear stress (τ) decreased at the anastomotic site. However, There was no significant difference between contralateral blood vessels (P> 0.05). Vm of upper and lower extremity vascular anastomoses were higher than that of uninvolved group, SV was decreased and τ was decreased, but the difference was not statistically significant (P> 0.05), regardless of follow-up time ≤24 weeks or> 24 weeks. There was no significant difference in the pulsatile flow index (PI) between the two groups (P> 0.05). Patients who were followed up for less than 24 weeks had higher Vm than those who were> 24 weeks after operation, and both SV and τ decreased. However, there was no significant difference between the two groups (P> 0.05). Conclusions Hemodynamic parameters and vessel wall shear stress are good parameters to assist in assessing the effect of anastomosis and repair of vascular injury. Regular and continuous observation is helpful to predict the outcome of anastomosis and repair of blood vessels.