彩色多普勒超声在血液透析患者自体动静脉内瘘血流量测量中的应用

目的探讨彩色多普勒超声在自体动静脉内瘘血流量测量中的应用价值。方法彩色多普勒超声测量自体动静脉内瘘血流量,以超声稀释法作为金标准,采用Pearson线性相关比较其一致性。结果共103例低位桡动脉-头静脉吻合的自体动静脉内瘘患者纳入本研究,超声稀释法测量内瘘流量(Qa)为(955.1±441.0)ml/min,彩色多普勒超声测量头静脉流量为(914.2±468.5)ml/min,肱动脉流量为(915.8±405.9)ml/min。所有患者中,肱动脉流量与头静脉流量均与Qa显著相关(P<0.001),且肱动脉相关系数R高于头静脉(0.856 vs 0.808)。在鼻烟窝、腕部、前臂等不同部位亚组中,肱动脉相关系数R均高于头静脉。在11例(10.7%)高流量内瘘中,头静脉流量与Qa相关性(R=0.852)高于肱动脉(R=0.773)。结论彩色多普勒超声可用于自体动静脉内瘘血流量监测,测量部位首选肱动脉,但是在高流量内瘘中,测量部位可选择头静脉。

Color Doppler Ultrasonography for the Measurement of Access Blood Flow in Hemodialysis Patients with Native Arteriovenous Fistula

Objective To evaluate the clinical value of color Doppler ultrasonography for the measurement of access blood flow in hemodialysis patients with native arteriovenous fistula.Methods Color Doppler ultrasound was performed to measure access blood flow,using the ultrasound dilution method as the gold standard.Pearson linear correlation was used to evaluate the consistency between the two methods.Results 103 patients were enrolled in the study.The mean values of blood flow obtained with color doppler ultrasound were(914.2±468.5)ml/min in the cephalic vein,(915.8±405.9)ml/min in the brachial artery.Both were significantly correlated with blood flow obtained with ultrasound dilutionQa(955.1±441.0)ml/min,both P<0.001]Blood flow in the brachial artery showed a greater correlation with Qa than the cephalic vein in all patients(R=0.856 vs 0.808),and in different anastomosis subgroups.For 11 patients with high flow fistulas(10.7%),blood flow measured in the cephalic vein showed a greater correlation(R=0.852)than the brachial artery(R=0.773).Conclusions Color Doppler ultrasound represents a good indirect method for blood flow measurement of native arteriovenous fistula.In general,brachial artery is more suitable for ultrasound measurement than cephalic vein except for high blood flow fistulas.