超声在桡动脉-头静脉自体动静脉内瘘术前评估的价值

The value of ultrasound in preoperative evaluation of radial-cephalic autogenous arteriovenous fistula

目的探讨超声在血液透析患者前臂桡动脉-头静脉自体动静脉内瘘(RC-AVF)术前评估的应用价值。方法根据术后2~12周随访结束时内瘘的状态,将行前臂RC-AVF术的201例患者分为成功组和失败组,分析超声评估内瘘状态的价值。结果RC-AVF内瘘成熟的危险因素是桡动脉硬化(OR=6.432,P=0.007);保护因素包括桡动脉内径宽(OR=0.090,P=0.010)、桡动脉峰值流速快(OR=0.951,P=0.010)和头静脉扩张后内径宽(OR=0.008,P=0.001)。在头静脉内径<2.0 mm的患者,头静脉扩张后内径取1.9 mm时获得最佳界值,ROC曲线下面积为0.779[95%CI(0.694~0.850)],诊断灵敏度为75.0%,特异度为68.9%。结论RC-AVF术前超声检查可对血管行有效的评估,提高手术成功率。

Objective To explore the application value of ultrasound in the preoperative evaluation of radial-cephalic autogenous arteriovenous fistula(RC-AVF)in the patients undergoing hemodialysis.Methods According to the results of RC-AVF fistula at the end of 2-12 weeks of follow-up,201 patients were divided into succeful group and failure group.The value of ultrasound in evaluating the status of internal fistula was analyzed.Results The risk factor for RC-AVF fistula maturity was radial arteriosclerosis(OR=6.432,P=0.007).The protective factors for RC-AVF included wider radial artery diameter(OR=0.090,P=0.010),quicker peak radial artery flow(OR=0.951,P=0.010),wider and inner diameter of cephalic vein after dilatation(OR=0.008,P=0.001).Taking 1.9 mm as the best cutoff value,the area under ROC curve was 0.779[95%CI(0.694~0.850)]and the diagnostic sensitivity and specificity were 75.0%and 68.9%,respectively,in the patients with inner diameter<2.0 mm of the cephalic vein after dilatation.Conclusion RC-AVF preoperative ultrasound examination can effectively evaluate blood vessels and improve the success rate of surgery.