腕部自体动静脉内瘘术前血管超声检查的临床应用价值

目的探讨腕部桡动脉-头静脉内瘘(radiocephalic arteriovenous fistula,RCAVF)术前血管超声检查的临床应用价值。方法选自2016年08月~2019年01月于包头市中心医院血液透析中心首次行腕部RCAVF的患者135例,术前进行彩色多普勒超声检查。RCAVF通畅定义为可满足双针穿刺、泵控血流量>200 ml/min维持连续血液透析治疗6次以上者,并根据腕部RCAVF结局分组进行对比分析。结果腕部RCAVF通畅组99例,失功组24例,死亡或肾移植共12例。12个月时RCAVF通畅率为81%,24个月和32个月均为77%。二元Logistic回归分析,术前超声检查头静脉内径是RCAVF通畅的独立危险因素(OR=4.05,95%CI:1.49~11.01,P=0.006)。ROC曲线分析示头静脉内径的曲线下面积为0.707,最佳临界值为2.075mm。结论术前头静脉内径是预测腕部RCAVF内瘘日后通畅的最佳指标。

The clinical value of preoperative color Dopppler ultrasound examination of wrist blood vessels for the prediction of arteriovenous fistula maturation

Objective The aim of this study was to assess the accuracy of pre-operative ultrasound examination for predicting maturation of wrist radio-cephalic arteriovenous fistula(RCAVF).Methods A total of 135 patients with the first operation of RCAVF performed from August 2016 to January 2019 were enrolled in this study.Ultrasound examination for the preparation of RCAVF was conducted before the operation.RCAVF maturation was defined as the successful cannulation of fistula with two needles,delivery of blood at a flow rate>200 ml/min and blood access via fistula for at least six consecutive sessions.A comparative analysis was performed for RCAVF outcomes.Results There were ninety-nine wrist RCAVF in the patency group,twenty-four in the dysfunctional group,and twelve cases died or changed to kidney transplantation.The RCAVF patency rate was 81%at 12 months and 77%at 24 months and 32 months.Binary logistic regression analysis suggested that preoperative cephalic vein internal diameter measured by ultrasound examination was an independent risk factor for RCAVF patency(OR=4.05,95%CI:1.49~11.01,P=0.006).ROC curve analysis showed that the area under the curve of the cephalic vein diameter was 0.707,and the optimal threshold was 2.075 mm.Conclusion Preoperative ultrasonography for the preparation of RCAVF showed that internal diameter of the cephalic vein was the best predictor for RCAVF patency.