目的应用超声测量患者自体动静脉内瘘情况，分析内瘘动脉端不同穿刺方法和穿刺方向对内瘘的影响。 方法便利抽样法选取2023年3—10月在深圳市某三级甲等医院进行维持性血液透析的184名患者，使用超声测量内瘘动脉端血管直径、内膜增生厚度、吻合口直径等参数。 结果比较动脉端不同的穿刺方式发现,不同穿刺方法间动脉瘤发生率存在差异（ P ＜0.05）；在透析血流量方面，双向组大于离心组，离心组大于向心组（均 P ＜0.05）；而在血管结构上，离心组内膜增生厚度大于向心组（ P ＜0.05）。Logistic回归分析显示，年龄、内瘘使用时长、区域穿刺是动脉瘤形成的危险因素（ P ＜0.05）；而内瘘使用时长与离心穿刺是内膜增生的危险因素（ P ＜0.05）。 结论采用合理的内瘘穿刺方法和穿刺方向，避免区域穿刺和离心穿刺有助于降低血管动脉瘤的发生率和减轻血管内膜的增生。

Objective To analyze the effect of different puncture Methods and directions on autogenous arteriovenous fistula (AVF) by using ultrasound examination to measure the conditions of AVF in maintenance hemodialysis patients(MHD).Methods A convenience sampling method was used to select 184 MHD patients from a tertiary grade A hospital in Shenzhen from March to October 2023.The diameter of the arterial sector of AVF,the thickness of intimal hyperplasia,and the diameter of the anastomotic stoma were measured by ultrasound examination.Results A comparison of different puncture Methods at the arterial end revealed significant differences in the incidence of aneurysms among the Methods ( P ＜0.05).In terms of blood flow rate,the antegrade cannulation group was smallest,with bidirectional cannulation group largest ( P ＜0.05).The intimal hyperplasia thickness of the retrograde cannulation was larger than that of the antegrade cannulation ( P ＜0.05).Logistic regression analysis showed that age,the duration of AVF using,regional cannulation were related to the formation of aneurysm ( P ＜0.05).The duration of AVF using and retrograde cannulation method could promote the intimal hyperplasia ( P ＜0.05).Conclusions Reasonable puncture Methods and direction on autogenous arteriovenous fistula ,avoiding regional and retrograde cannulation can help to reduce the incidence of vascular aneurysm and intimal hyperplasia.

R473.55

2022年深圳市人民医院中青年科研基金院内课题（SYHL2022-N0001）