【摘要】目的探索掌上超声实时引导内瘘初期穿刺的可行性，并观察其与传统穿刺方法相比对于提高穿刺安全性的作用。方法选择2016 年9 月～2017 年8 月于北京市海淀医院肾内科行腕部桡动脉-头静脉自体动静脉内瘘成形手术并经临床及彩色多普勒超声判定内瘘成熟患者，连续入组60 例，随机分为超声实时引导穿刺组(观察组)，传统穿刺方法盲传穿组(对照组)。结果2 组患者入组时基线数据如年龄、体质量指数、性别构成比、合并症糖尿病、高血压、冠状动脉疾病、内瘘龄等差别无统计学意义(P＞0.05)；观察组穿刺前评估时间及穿刺时间均长于对照组[(123.2±47.7)s 比(40.4±30.6)s，t=19.145，P＜0.001]，[(48.6±20.2)s 比(32.0±30.7)s，t=2.556，P=0.011]；观察组1 次穿刺成功率高于对照组(100.0%比96.5%，χ2=6.393，P=0.011)，平均尝试次数少于对照组(1.0±0，比1.0±0.2，t=6.519，P＜0.001)，差异有统计学意义；2 组患者总穿刺损伤发生率为5.2%，观察组穿刺损伤发生率及程度均低于对照组(2.8%比7.3%，χ2=4.150，P=0.042)，差异有统计学意义；观察组患者因穿刺损伤导致应用导管透析次数少于对照组(1.1%比5.6%)，但2 组间差别无统计学意义(χ2=2.759，P=0.097)；2 组患者均未出现误穿动脉及因穿刺继发感染的情况。结论掌上超声实时引导自体动静脉内瘘穿刺可以提高内瘘穿刺成功率，并降低穿刺相关并发症，是一种切实可行的方法，值得临床推广。

【Abstract】Objective To explore the feasibility of handheld ultrasound examination for real- time guidance on cannulation of new arteriovenous fistula (AVF), and to compare its effects to the standard cannulation method. Methods This was a single center, randomized and prospective study comparing the handheld ultrasound examination-guided cannulation to new AVF with the standard cannulation method. Sixty end stage renal disease patients with a new and mature wrist radial-cephalic AVF treated in this hemodialysis center were enrolled in this study. Patients with new AVF received either standard cannulation (control group) or ultrasound guided cannulation (study group) for one week. Cannulation manipulation and complications were observed. Results Baseline data including age, body weight index, gender and comorbidities had no statistical significances between the two groups (P＞0.05). Compared to control group, study group yielded longer assessment time before cannulation (123.2±47.7s vs. 40.4±30.6s;p t=19.145, P＜0.001), longer cannulation time (48.6±20.2s vs. 32.0±30.7s; t=2.556, P=0.011), higher success rate (100.0% vs. 96.5%; χ2=6.393, P=0.011), and lower number of cannulation attempts (1.0 vs. 1.0±0.2; t=6.519, P＜0.001). The puncture injury rate was totally 5.2% in the patients; cannulation injury rate was lower in study group than in control group (2.8% vs. 7.3%; χ2=4.150, P=0.042). Change to catheterization for blood access due to cannulation injury was lower in study group than in control group but without statistical significance (1.1% vs. 5.6%; χ2=2.759, P=0.097). No puncture into arteries and infection due to cannulation were found in both groups. Conclusion Handheld ultrasound examination for real-time guidance on cannulation for new AVF can increase the success rate and decrease the cannulation-related complications. It is a safe and useful method for blood access to be used widely in clinical practice.