中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (11): 761-765.doi: 10.3969/j.issn.1671-4091.2018.11.010

• 血管通路 • 上一篇    下一篇

超声检查在评估自体动静脉内瘘成熟过程中的应用价值

闫永宏1,侯国存2,王慧2,孙秀丽2,殷娜2,冯国徵2,陈爱珍2,郭静2   

  1. 包头市中心医院1超声科2肾内科血液透析中心
  • 收稿日期:2018-03-13 修回日期:2018-09-19 出版日期:2018-11-12 发布日期:2018-11-13
  • 通讯作者: 侯国存 houguocun2007@163.com E-mail:houguocun2007@aliyun.com

he application of color Doppler ultrasound in evaluating the maturation process of arteriovenous fistula

  • Received:2018-03-13 Revised:2018-09-19 Online:2018-11-12 Published:2018-11-13

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摘要： 【摘要】目的通过对新建立的腕部桡动脉-头静脉吻合内瘘(radial-cephalic arteriovenous fistula，RC-AVF)术后超声随访检查，明确RC-AVF 的自然成熟过程。方法收集本中心符合纳入标准的新建立RC-AVF 的患者。术后第2～24 周进行规律超声随访检查。通过重复测量方差分析超声监测指标随时间的变化特点，进一步采用ROC 曲线分析相关指标对于内瘘成熟的诊断效能。结果24 周时RC-AVF的通畅率为71.43%。超声监测指标随时间的变化特点显示：肱动脉内径和头静脉内径在RC-AVF 术后的第2～24 周内随时间呈增大的变化趋势(F=3.070，P=0.047；F=7.649，P＜0.001)；2 者在4 周内的变化明显(t=-2.338，P=0.026；t=-4.792，P=0.003)。通畅组与失败组比较结果显示：头静脉内径和头静脉血流量从术后第2～24 周2 组间的差异始终具有显著性(P＜0.05)。ROC 曲线分析示头静脉内径=4.28mm 为最佳临界值(AUC=0.882)，其预测AVF 成熟的敏感度为81.82%，特异度为86.67%；头静脉血流量=701.580ml/min 为最佳临界值(AUC=0.873)，其预测AVF 成熟的敏感度为72.73%，特异度为93.33%。结论新建立的RC-AVF 在术后的4 周内快速成熟，头静脉内径和头静脉血流量是判断RC-AVF 成熟的主要标志，诊断的最佳临界值分别为4.28mm 和701.580ml/min。

关键词: 桡动脉-头静脉吻合内瘘, 彩色多普勒超声, 内瘘成熟, 头静脉内径

Abstract: 【Abstract】Objective To explore the ultrasonic examination for the evaluation of maturation process of newly established radial- cephalic arteriovenous fistula (RC-AVF) within 24 weeks after surgery. Method In this single center clinical study, RC-AVFs performed from October 2016 to January 2018 were included in this study. Ultrasound follow-up examinations were performed after surgery. Patients were divided into patency group and failure group. The ultrasonic parameters at different follow-up time points were compared. ROC curve was used to analyze the diagnostic value of ultrasonic monitoring parameters. Results The patency rate of RC-AVF at the 24th week was 71.43%. The internal diameter of brachial artery (t=-2.338, P=0.029) and cephalic vein (t=- 4.792, P=0.003) increased gradually within 4 weeks after surgery in patency group, while the changes were not significant between 4th to 24th week (P> 0.050). The internal diameter of cephalic vein and its blood flow were always significantly different between the two groups during the follow-up period (P ＜0.05). When the optimal cut-off value of cephalic vein diameter was set at 4.28mm, the sensitivity and specificity were 81.82% and 86.67% respectively for predicting maturation of AVF and AUC=0.882; when the optimal cut-off value of blood flow in cephalic vein was set at 701.580ml/min, the sensitivity and specificity were 72.73% and 93.33% respectively for predicting maturation of AVF and AUC=0.873. Conclusion The newly established RC-AVF matures rapidly within 4 weeks after surgery. The internal diameter of cephalic vein and its blood flow were the main parameters of RC-AVF maturity. The optimal cut-off values for the diagnosis of RC-AVF maturation were internal diameter of cephalic vein 4.28mm and blood flow in cephalic vein 701.580ml/min respectively.

Key words: Radial-cephalic arteriovenous fistula, Color Doppler ultrasound, Maturation, Internal diameter of cephalic vein