彩超评价血液透析自体动静脉内瘘血栓诊治

目的：探讨超声在透析患者自体动静脉内瘘血栓形成诊断及治疗随访中应用价值。方法：87例临床疑似内瘘血栓形成患者，使用高频彩超检查内瘘，扫查内瘘动脉流入道及静脉流出道近心端、远心端、瘘口二维、血流显像及血流频谱测量其收缩期峰值（PSV）、舒张期流速（EDV），阻力指数（RI）。血栓形成不超过48h行超声引导下“尿激酶注入＋外部按压”方法溶栓。结果：在临床疑似血栓形成87例，超声检查：23％显示正常，77％并发症其中：40．2％附壁血栓形成（其中静脉侧26例，动脉侧4例，动脉侧、瘘口及静脉侧5例），36．8％静脉侧完全血栓形成（11例施行溶栓，其中9例成功溶栓，2例溶栓未通，13例手术取栓，8例长期插管）；超声引导下“尿激酶注入＋外部按压”溶栓法和手术取栓对于内瘘使用期影响：溶栓与手术没有差异。结论：彩超是可以安全可靠评估血液透析自体动静脉内瘘血栓情况，在超声引导下溶栓和取栓，减少盲目性，延长内瘘的使用寿命。

Color Dupplex Sonographic Value in the Thrombosed Native Arteriovenous Fistulae Diagnosis and Follow- up of the for Hemodialysis

Objective：To discuss the detection of the native arteiovenous fistulae thrombosis and the follow - up in the thrombolysis process with uhrasonic imaging. Methods：87 patients were found to suspect vascular access thrombus, in clinic check -up which were scanned with ultrasound, the aterial access inflow or the venous outflow proximal and distal, fistulae two - dimension, color flow imaging were mapped, the peak systolic velocity （ PSV）, the end diastolic velocity （ EDV）, the resistent index （RI） were measured respectively. The thrombus which were no more than 48 hours were treated by the ＂lysis and outer - compression with hand＂ under the ultrasonic detection. Results： Color Doppler imaging of the access suspect thrombus during hemodialysis, some are normal 23% , the other are abnormal 77% , among .those： 40. 2% （26 for the venous ones, 4 for the arterial ones, 5 for the venous, arterial and fistulae. 36. 8% the complete venous ones （ 11 for thrombolysis, among these, 9 for the success,2 for the failure, 13 for the operation,8 for the long cannulation ）. There is a no difference between the thrombolysis which is detected by the ＂lysis and outer - compression with hand＂ under the ultrasonic detection, and the operation. Conclusions ： Color imaging is a primary non - invasive diagnostic modality for evaluation of hemodialysis arteriovenous fistula thrombus, it is valuable of the ultrosonic detection for thrombolysis and operation, for decrease of the blindness and extension of the longevity of the access.