【摘要】目的  探讨彩超评估对发现Kt/V 达标且功能正常的自体动静脉内瘘并发症的价值，彩超测量参数与泵控血流量的关系及彩超评估对临床实践的影响。方法  入选维持性血液透析患者68 例,收集基本临床资料、相关生化指标。所有患者透析前行内瘘彩超评估，记录彩超测量参数及有无并发症。按是否存在狭窄分2 组，比较一般临床资料、内瘘彩超测量参数有无差异。结果  ①彩超发现内瘘狭窄、动脉瘤、血栓、钙化、侧枝开放、桡动脉反流发生率分别为33.8%(23/68)、14.7%(10/68)、16.2%(11/68)、19.1% (13/68)、33.8% (23/68)、28.8% (17/59)；② 与B 组( 无狭窄组) 比较，A 组( 狭窄组) 年龄更大(t=2.559,P=0.013),手术部位在前臂远端更多(χ2=5.302，P=0.021),泵控血流量，吻合口直径，肱动脉直径，穿刺部位血流量，肱动脉血流量均偏小(t 值分别为-2.710,-2.987，-2.711，-2.158,-2.657；P 值分别为0.009，0.004，0.009，0.035，0.010)，差异有统计学意义。Pearson 相关分析显示，泵控血流量与吻合口直径、穿刺部位直径、桡动脉直径、肱动脉直径、穿刺部位血流量、肱动脉血流量呈正相关(r 值分别为0.452，0.441，0.469，0.445，0.369，0.384；P 值分别为＜0.001，＜0.001，＜0.001，＜0.001，0.002，0.001)。③根据内瘘彩超评估结果，共行经皮血管成形术(percutaneous angioplasty，PTA)治疗5 例；外科手术内瘘重建1 例；重新规划调整穿刺部位共20 例；确定每1～3 月内瘘彩超评估共30 例。结论  彩超评估发现功能正常的自体动静脉内瘘存在比例较高的各种并发症；内瘘彩超测量参数和内瘘血流量具有良好的相关性，可用于监测内瘘功能；彩超评估结果可用于指导动静脉内瘘管理的临床实践。

【Abstract】Objective To study the value of color Doppler ultrasound examination to find out complications in functional autogenous arteriovenous fistula (AVF) with target Kt/V value, to analyze the relationship between color Doppler ultrasound parameters and pump-controlled blood flow, and to evaluate the impact of color Doppler ultrasound findings on clinical practice. Methods A total of 68 maintenance hemodialysis (MHD) patients were enrolled in this study. Their clinical and biochemical data and color Doppler ultrasound examination results were collected. The patients were then divided into fistula stenosis group and non-fistula stenosis group. Results ①Color Doppler ultrasound examination found the many complications, including stenosis (23/68 cases, 33.8%), aneurysm (10/68 cases, 14.7%), thrombosis (11/68 case, 16.2%), calcification
(13/69 cases, 19.1%), vascular branches (23/68 cases, 33.8%), and distal radial artery reflux (17/59 cases, 28.8%). ② Compared with non-fistula stenosis group, fistula stenosis group had older age (t=2.559, P=0.013),more fistulas located at distal forearm (χ2=5.302,P=0.021), lower pump- controlled blood flow (t=- 2.710, P=0.009), smaller diameters of anastomosis orifice (t=-2.987, P=0.004) and brachial artery (t=-2.711, P=0.009), lower blood flow at the puncture site (t= -2.158, P= 0.035), and reduced blood flow in brachial artery (t=-2.657, P=0.010). Pearson correlation analysis showed that pump- controlled blood flow was positively correlated with the diameters of anastomosis orifice (r=0.452, P＜0.001), puncture site (r=0.441, P＜0.001), radial artery (r=0.469, P＜0.001) and brachial artery (r=0.445, P＜0.001), and blood flow volumes at the puncture site (r=0.369, P=0.002) and in brachial artery (r=0.384, P=0.001). ③Based on the results of color Doppler ultrasound examinations, percutaneous angioplasty was performed in 5 cases, surgical reconstruction in one case, and rEadjustment of the puncture site in 20 cases. Repeated color Doppler ultrasound examinations were required every 1- 3 months in 30 cases. Conclusion Color Doppler ultrasound examinations found higher rates of complications in functional AVFs with target Kt/V value. Color Doppler ultrasound parameters were closely related to the blood flow in AVFs, indicating that color Doppler ultrasound examination is useful for monitor of AVF functions and management of AVFs in clinical practice.