目的 探讨导声垫在自体动静脉内瘘狭窄超声检查中的应用价值。方法 对31例自体动静脉内瘘静脉通路狭窄患者行上肢血管超声检查，在分别使用耦合剂、应用导声垫情况下采集数据，对比使用不同透声媒质时静脉内径测量的可重复性，以及评估狭窄处内径与肱动脉流量的相关性。 结果 31例均为腕部桡动脉-头静脉端侧吻合，4例狭窄处位于瘘口头静脉端，27例狭窄处位于头静脉前臂段；使用耦合剂测量狭窄处内径(1.41±0.45)mm，使用导声垫测量狭窄处内径(1.89±0.53)mm，差异具有统计学意义(t=-3.806，P＜0.001)。耦合剂组观察者间ICC为0.887(95%CI:0.761～0.946，P＜0.001)，导声垫组观察者间ICC为0.974(95%CI:0.948～0.988，P＜0.001)。多普勒超声测量上臂中段肱动脉流量为(381.29±159.77)ml/min，使用耦合剂和使用导声垫测量狭窄处内径与肱动脉流量均呈显著相关(r=0.765、0.817，均P＜0.001)。 结论 自体动静脉内瘘静脉通路狭窄患者行上肢血管超声检查时，使用导声垫可减少静脉受压形变，且测量静脉内径的可重复性高于使用耦合剂，其测值与肱动脉流量相关性更好。
Objective To investigate the value of ultrasound gel pad during the ultrasound examination of autologous arteriovenous fistula (AVF) stenosis. Methods A total of 31 patients with AVF and venous access stenosis were subjected to ultrasound examination of the blood vessels in the upper extremity. The residual diameter of stenosis was measured using different transaudient medium: ultrasound gel pad and coupant. The repeatability and correlation with brachial artery blood flow were evaluated. Results All of the 31 cases had end-to-side anastomosis of radial artery-cephalic vein fistula in wrist. The stenosis located in the venous end of the fistula in 4 cases, and located in the forearm segment of cephalic vein in 27 cases. The residual diameter at the stenosis site was 1.41±0.45 mm measured with couplant, and was 1.89±0.53 mm measured with ultrasound gel pad, the difference was statistically significant (t=-3.806, P<0.001). The inter-observer correlation coefficient (ICC) with couplant was 0.887 (95% CI: 0.761~0.946, P<0.001), and was 0.974 (95% CI: 0.948~0.988, P<0.001) with ultrasound gel pad. The brachial artery flow measured by Doppler was 381.29±159.77 ml/min. The residual diameter of stenosis measured with couplant was significantly correlated with brachial artery flow (r=0.765, P<0.001). The measurement with ultrasound gel pad was also significantly correlated with brachial artery flow (r=0.817, P<0.001). Conclusion When vascular ultrasonography was performed in patients with AVF and venous access stenosis, ultrasound gel pad can reduce the compression deformities of the veins. Ultrasonography of AVF stenosis using ultrasound gel pad has a better repeatability and a better correlation with brachial artery blood flow than those using couplant.
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