中国血液净化

中国血液净化 ›› 2019, Vol. 18 ›› Issue (04): 266-269.doi: 10.3969/j.issn.1671-4091.2019.04.015

• 血管通路 • 上一篇    下一篇

腕部桡动脉-头静脉内瘘成形术前及早期术后超声检查的临床价值

侯国存1,何斌2,闫永宏3,孙秀丽1,侯毅3,殷娜1,冯国徵1,陈爱珍1   

  1. 1. 包头市中心医院肾内科血液透析中心
    2. 包头市第三医院检验科
    3. 包头市中心医院超声科
  • 收稿日期:2018-10-04 修回日期:2018-12-20 出版日期:2019-04-12 发布日期:2019-04-12
  • 通讯作者: 侯国存 houguocun2007@163.com E-mail:houguocun2007@aliyun.com

The value of color Doppler ultrasound examination of wrist radiocephalic arteriovenous fistula to predict maturity

  • Received:2018-10-04 Revised:2018-12-20 Online:2019-04-12 Published:2019-04-12

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摘要： 【摘要】目的探讨腕部桡动脉-头静脉内瘘(radiocephalic arteriovenous fistula, RC-AVF)手术术前和术后2 周彩色多普勒超声检查在预测内瘘成熟的临床价值。方法选自2015 年10 月～2017年12 月于包头市中心医院血液透析中心行腕部RC-AVF 患者，术前和术后2 周行彩色多普勒超声检查。自体动静脉内瘘成熟的定义为可进行双针穿刺，泵控血流量＞200ml/min，维持至少6 次连续血液透析治疗。结果RC-AVF 术后2 周超声检查头静脉内径(cephalic vein internal diameter,Dcv-术后)和肱动脉收缩期峰值流速(brachial artery peak systolic velocity,PSVbr-术后)是AVF 成熟的独立危险因素(c2=48.253，P＜0.001)。ROC 曲线分析示Dcv- 术后的曲线下面积(area under the curve，AUC) 为0.939，4.285mm 为最佳临界值；PSVbr-术后的AUC 为0.830，134.750cm/s 为最佳临界值。结论腕部RC-AVF 术前超声检查与内瘘成熟无相关性，术后2 周超声检查显示Dcv-术后＞4.285mm 是内瘘日后成熟的最佳预测指标，为临床早期干预提供重要参考。

关键词: 腕部桡动脉-头静脉内瘘, 成熟, 彩色多普勒超声, 头静脉内径, 肱动脉收缩期峰值流速

Abstract: 【Abstract】Objective The aim of this study was to assess the accuracy of pre-operative and post-operative ultrasound (US) examination for predicting maturity of wrist radio-cephalic arteriovenous fistula (RC-AVF). Method The patients with the operation of RC-AVF performed from October 2015 to December 2017 were enrolled in this study. US examination for RC-AVF was conducted before the operation and after the operation for 2 weeks. RC-AVF maturation was defined as the successful cannulation of fistula with two needles, delivery of blood at a flow rate ≥ 200 ml/min for 4 hours via the access, and dialysis via the fistula for at least six consecutive sessions. Results Eighty-two wrist RC-AVFs were analyzed, of which 13 failed. Pre-operative US parameters did not correlate with RC-AVF maturity. Cephalic vein diameter (CVD) ＞4.285 mm and brachial artery peak systolic velocity (BAPSV) ＞134.75 cm/s from US examination were the best post-operative predictors of RC-AVF maturity (P＜0.001 and 0.011, respectively). Conclusions T wo weeks after surgery, a new wrist RC-AVF with a CVD ＞4.285 mm is suitable for dialysis. Early intervention to a high-risk failure AVF would thus be possible.

Key words: Wrist radiocephalic arteriovenous fistula, Maturation, Color Doppler Ultrasound, Cephalic vein internal diameter, Brachial artery peak systolic velocity