| Objective:To investigate the hemodynamic changes of autogenous arteriovenous fistula(AVF)in patients with chronic renal failure(CRF)by using ultrasound imaging technology.Method:From March 2021 to March 2022,patients in the Department of Nephrology of Nanchong Central Hospital who used temporary channels to maintain HD for more than 3 months were enrolled.86 patients with chronic renal insufficiency were selected as the hemodialysis(HD)case group,the anastomosis location of the arteriovenous fistula(AVF)was radial artery(RA)and cephalic vein on the non-dominant side of the forearm,and the maintenance HD time was more than 3 months.According to the brachial artery(BA)flow of 500mL/min at 6 weeks after operation,the patients were further divided into normal flow group(HD A group,500mL/min-1499 mL/min,n=56)and insufficient flow group(HD B group,<499mL/min,n=30).The superior mesenteric artery(SMA),bilateral BA,RA on the proximal and non-dominant side of the stoma,and common carotid artery(CCA)were obtained by Philips EPIQ 7C ultrasound diagnostic system.CAA,blood vessel diameter of calf intermuscular artery,and hemodynamic parameters including peak systolic velocity(PSV),resistance index(RI),and pulsatility index(PI).Data collection time points were 1 day before surgery,1 day after surgery and 6 weeks after surgery in HD group,and data collection time points were collected three times(1 day,3 days and 6 weeks)in HC group.The hemodynamic parameters were compared between the HD group and the HC group before and after AVF.Result:1 Comparison of basic data1.1 There was no significant difference in gender,age and height among the three groups(P>0.05),but there was a significant difference in smoking history(P<0.05);There was no significant difference in chronic glomerrulon-ephritis(CGN),hypertension,diabetes,polycystic kidney disease,diseases without obvious etiology and dialysis time between HD A and HD B group(P>0.05);Compared with HC group,blood urea nitrogen(BUN),serum creatinine(Scr),triglyceride(TG)in HD A and HD B groups were significantly decreased.TG),calcium-phosphorus product([Ca]×[P]),and parathyroid hormone(PTH)were significantly increased,and hemoglobin(Hb)was decreased,with statistically significant differences(P<0.05).There was no significant difference in total cholesterol(TC)(P>0.05).1.2 Horizontal comparison of basic data among HD A group,HD B group and HC group1.2.1 One day before AVF:The SBP and DBP in HD A group and HD B group were higher than those in HC group(P<0.05),while there was no significant difference in blood pressure between HD A group and HD B group(P>0.05);There was no significant difference in heart rate(HR)among the three groups(P>0.05).1.2.2 One day after AVF and 6 weeks after AVF:The SBP,DBP and HR in HD A and HD B groups were higher than those in HC group(P<0.05);The DBP in HD B group was higher than that in HD A group(P<0.05),and there was no significant difference in SBP and HR between HD B group and HD A group(P>0.05).1.3 Intra-group longitudinal comparison of baseline data at 1 day and 6 weeks after surgery1.3.1 There was no significant difference in body SBP,DBP and HR in HC group(P>0.05).1.3.2 Compared with 1 day before operation,SBP and DBP were decreased and HR was increased 1 day and 6 weeks after operation in HD A and HD B groups(P<0.05);Compared with 1 day after operation,SBP and DBP were decreased in HD A and HD B groups at 6 weeks after operation(P<0.05).2.1 Comparison of arterial structural parameters2.1.1 CCA intima-media thickness(IMT):At the three time points,HD A group and HD B group were higher than HC group,and HD A group and HD B group were higher at 6 weeks after operation than at 1 day before operation(P<0.05).2.1.2 Vessel inner diameter parameters:At 1 day and 6 weeks after operation,the inner diameter of BA and RA at the proximal end of stoma in HD A and HD B groups were higher than those in HC group,and those in HD B group were lower than those in HD A group(P<0.05);In HD A and HD B groups,the inner diameter of BA on the stoma side and the inner diameter of RA at the proximal end of the stoma at 1 day and 6 weeks after operation were higher than those at 1 day before operation,and those at 6 weeks after operation were higher than those at 1 day after operation(P<0.05);The inner diameter of CCA on the stoma side in HD A group was higher than that in HC group at 1 day after operation,and the inner diameter of CCA on the stoma side in HD A group was higher at 1 day after operation than that at 1 day before operation(P<0.05).2.2 Transverse comparison of vascular spectral parameters among HD A group,HD B group and HC group2.2.1 BA on the stoma side and RA at the proximal end of the stoma:BA PSV,VFlow and RA PSV in HD A group and HD B group were higher than those in HC group at 1 day and 6 weeks after operation,and BA RI,PI,RA RI and PI were lower than those in HC group(P<0.05);BA PSV,VFlow and RA PSV in HD B group were lower than those in HD A group at 1 day and 6 weeks after operation,while BA RI,RA RI and PI were higher than those in HD A group(P<0.05).2.2.2 Contralateral upper limb BA:PSV in HD A group was lower than that in HC group at 1 day and 6 weeks after operation(P<0.05);PSV in group HD B was lower than that in group HC at 1 day after operation(P<0.05);RI and PI in HD A and HD B groups were higher than those in HC group at 1 day after operation(P<0.05).2.2.3 CCA on the stoma side:PSV in HD A and HD B groups was higher than that in HC group at 1 day and 6 weeks after operation,RI and PI were lower than those in HC group at 1 day after operation(P<0.05).2.2.4 SMA:PSV,RI and PI in HD A group and HD B group were higher than those in HC group at three time points(P<0.05);The RI and PI in group HD B were lower than those in group A at 1 day and 6 weeks after operation(P<0.05).2.2.5 Calf intermuscular arteries of the lower limbs:PSV in HD A group and HD B group was lower than that in HC group at 1 day and 6 weeks after operation(P<0.05),and there was no significant difference in RI and PI(P>0.05).2.3 Intra-group longitudinal comparison of vascular spectral parameters between 1 day after surgery and 6 weeks after surgery2.3.1 There was no significant difference in the longitudinal comparison of PSV,RI and PI in HC group(P>0.05).2.3.2 BA on the stoma side and RA at the proximal end of the stoma:Compared with 1 day before operation,BA VFlow,PSV and RA PSV in HD A group and HD B group were significantly increased,BA RI and PI,RA RI and PI were significantly decreased at 1 day and 6 weeks after operation(P<0.05).Compared with 1 day after operation,BA VFlow and RA PI were increased,and BA PSV,RA PSV and RA RI were decreased in HD A and B groups at 6 weeks after operation(P<0.05).2.3.3 Contralateral upper limb BA:Compared with 1 day before operation,PSV of HD group A and group B decreased 1 day and 6 weeks after operation(P<0.05);The RI and PI of HD group A and B were higher than those of HD group A and B at 1 day after operation(P<0.05).2.3.4 CCA on the stoma side:Compared with 1 day before operation,PSV of HD A group and HD B group increased 1 day and 6 weeks after operation(P<0.05);The RI and PI of HD A group and HD B group were lower than those of 1 day before operation(P<0.05).2.3.5 SMA:Compared with 1 day before operation,PSV was decreased 1 day after operation,RI and PI were increased 1 day after operation and 6 weeks after operation in HD A and B groups(P<0.05);PSV of HD group A and group B were higher at 6 weeks after operation than at 1 day after operation(P<0.05).2.3.6 Calf intermuscular arteries of the lower limbs:Compared with 1 day before operation,PSV of HD A group and B group decreased 1 day and 6 weeks after operation(P<0.05).Conclusion:Human hemodynamics is in a state of hyperdynamic circulation after HD,which promotes different vascular remodeling and changes in hemodynamic state and blood flow redistribution in HD patients.There are different changes in hemodynamics of different parts of blood vessels in HD A group and HD B group. |
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