The Clinical Study Of Ultrasonic Evaluation Of The Mature Time Of Upper Extremity Autogenous Arteriovenous Fistula

Objectives:Maintenance hemodialysis treatment is currently the most common and the most reliable way of end-stage renal disease,thus established maint enance hemodialysis pathway is especially important,known as the "lifeline" of patie nts with chronic renal failure[5].The upper extremity autogenous arteriovenous fistula is the most used and relatively less complicated hematopoietic pathway in China,whi ch has certain advantages.But for upper limb autogenous arteriovenous fistula in matu re and puncture time for the first time,there is no a unified standard of objective.This method until fistula puncture must also determine whether mature,at this stage t here is still no one without puncture can judge fistula in mature simple method,and th e first puncture for arteriovenous fistula in mature period and less time to study,know more scarce.The research purpose of this paper is through the retrospective analysis o f upper limb autogenous arteriovenous internal fistula in 30 cases of patients with data,combined with postoperative follow-up results of color doppler ultrasound evaluatio n of internal fistula maturity,and research of internal fistula puncture time,for the firs t time and discuss the influencing factors of internal fistula maturity.Methods:Choose between January 2017 and December 2017,the first affiliated hospi tal of kunming medical university renal medicine for chronic renal insufficiency end-s tage hemodialysis treatment must be conducted and upper limb autogenous arterioven ous internal fistula in 30 cases of patients were retrospectively study,the general situa tion and the primary disease of patients with complete record,and preoperative have c ompleted the color doppler ultrasound assessment is proposed to build fistula blood ve ssels,after 4 weeks follow-up results of color doppler ultrasound examination.The dia lysis was divided into two groups according to the clinical dialysis puncture test withi n 6 to 8 weeks after surgery.In the experimental group,there were 18 cases of internal fistula,in which 10 cases of male patients and 8 female patients were successfully co mpleted.12 cases in the control group,the internal fistula immature group,for the sm ooth completion of dialysis patients,8 cases of male patients,4 cases of female patien ts,30 cases of patients with chronic renal failure in male patients with 18 cases,aged 22 to 77 years old,average age(50.28± 16.40)years old.12 patients with women,age d 30～73years old,the average age(50.83 ± 13.71)years old.Compare two groups of patients with preoperative first inner diameter and the inner diameter of the radial arte ry and vein blood flow,the diameter of the postoperative anastomotic,cephalic vein a nd radial artery diameter and blood flow,and the experimental group and the control way in preoperative and postoperative cephalic vein diameter,radial artery diameter a nd blood flow.The receiver operating characteristic curve(ROC curve)was plotted by using the median blood flow rate of 4 weeks after the operation of the experimenta 1 group(the mature group of the internal fistula).The relevant data were statistically p rocessed.Results:Compared two groups of patients,the experimental group in preoperative radial artery diameter and blood flow,postoperative radial arrtery diameter and blood flow and cephalic vein diameter and blood flow were significantly higher than that of control group,The difference was statistically significant(P<0.05).However,there was no significant difference between the experimental group and the control group before the operation of the preoperative cephalic vein diameter and postoperative anastomosis diameter,and the difference was not statistically significant(P>0.05).The diameter of radial artery,blood flow of radial artery and the diameter of cephalic vein were significantly increased in the experimental group(P<0.05),while the diameter and the blood flow of the radial artery,and the diameter of the cephalic vein did not increase significantly in the control group after the operation(P>0.05).In the experimental group,the postoperative median blood flow of cephalic vein’s ROC curve was predicted maturity of AVF,the threshold value is 301.1ml/min.Conclusions:It is clear that the mature time of AVF can reduce the use of temporary hemodialysis access,thus reducing the complications caused by intubation.The study showed that the diameter and blood flow of the temporary radial artery could affect th e mature of AVF.When the preoperative diameter of the radial artery was greater than 2mm and the preoperative diameter of the cephalic vein was greater than 1.9mm,the postoperative AVF was more likely to mature.The AVF was mature when the diameter of the cephalic vein reached 4mm.When the blood flow of the postoperative cephalic vein reached 301.1ml/min,it was able to predict the maturity of AVF,which could be used as a basis for judging the maturity of AVF clinically.