【摘要】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。

【Abstract】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.