浸润式超声与接触式超声测量头静脉内径的可重复性研究

Study on the repeatability of infiltration ultrasound and contact ultrasound examinations in measuring cephalic vein diameter

目的评价浸润式、接触式超声在测量头静脉内径中的可重复性。方法由2名从事超声诊断工作10年以上的医师,对重庆医科大学附属大学城医院收治的38例预行桡动脉-头静脉内瘘成形术前的患者,在左前臂同一位置处、不同时间点,分别使用浸润式、接触式超声2种方法进行头静脉内径测量。使用组内相关系数(interclass correlation coefficient,ICC)评价测量的组内和组间一致性。并进行Bland-Altman绘图分析,以再次评价重复性。结果浸润式超声法测量值组内和组间一致性非常好,ICC分别为0.968(95%CI:0.939~0.983,P<0.001)和0.960(95%CI:0.924~0.979,P<0.001)。接触式超声法测量值组内和组间一致性好,ICC分别为0.718(95%CI:0.521~0.843,P<0.001)和0.692(95%CI:0.482~0.827,P<0.001)。浸润法超声测量头静脉内径的组内与组间Bland-Altman散点图中,落在95%一致性界限(limits of agreement,LOA)内的点均为97%,接触法超声组内与组间Bland-Altman散点图中,落在95%LOA内的点均为94%。浸润式超声获得头静脉二维图像中,近场组织结构更清晰、头静脉前壁与腔内结构更清楚。同时,浸润式超声显示检查范围更广,更容易同时显示头静脉与桡动脉。结论浸润式超声测量头静脉内径的重复性优于接触式超声,浸润式超声获得的二维图像中,近场组织结构及扫描检查范围均优于接触式超声,浸润式超声可作为桡动脉-头静脉内瘘术前测量头静脉内径的优选方法。

Objective To evaluate the repeatability of infiltration and contact ultrasound examinations in measuring cephalic vein diameter.Methods Thirty-nine patients were subjected to radial artery-cephalic vein internal fistula angioplasty in left forearm in University-Town Hospital of Chongqing Medical University.Before the surgery,their cephalic vein diameters were measured using infiltration ultrasound and contact ultrasound methods at the same position and at different time points by two professional physicians working in the ultrasonic diagnosis field for more than 10 years.Interclass correlation coefficient(ICC)was used to evaluate the intra-and inter-group consistency of the measurement.Bland-Altman plot analysis was performed to rEevaluate the repeatability.Results The intra-and inter-group consistency of the measurements were quite satisfactory using infiltration ultrasound,with the ICC values of 0.968(95%CI:0.939~0.983,P<0.001)and 0.960(95%CI:0.924~0.979,P<0.001)respectively.The intra-and inter-group consistency of the measurements were 0.718(95%CI:0.521~0.843,P<0.001)and 0.692(95%CI:0.482~0.827,P<0.001)respectively using contact ultrasound.In the Bland-Altman cephalic vein diameter scattergrams of intra-and intergroups,the points falling within the 95%LIMITS of agreement(LOA)were 97%in infiltration ultrasound group,and were 94%in contact ultrasound group.The two-dimensional images of cephalic vein,including the structure of proximal field,the anterior wall and intracavitary structure,were clearer in infiltration ultrasound group.Additionally,infiltration ultrasound had the advantages of bigger examination field and simultaneous display of cephalic vein and radial artery.Conclusion The repeatability of cephalic vein diameter measurement and the two-dimensional images of cephalic vein including the structure of proximal field and the scanning scope were better using infiltration ultrasound than using contact ultrasound.Therefore,infiltration ultrasound is a preferential method for cephalic vein diameter measurement before radial artery-cephalic vein internal fistula angioplasty.