摘要
目的研究维持性血液透析患者血管通路的应用情况,以及自体动静脉内瘘的相关并发症。方法收集上海交通大学附属第一人民医院376例维持性血液透析超过6月以上患者的资料,分为腕部内瘘组和肘部内瘘组,评估2组患者中与动静脉内瘘相关的并发症发生情况。结果 376例患者中,腕部内瘘占93.09%(350/376)、肘部内瘘4.79%(18/376)、移植内瘘1.33%(5/376)、带涤纶套导管0.80%(3/376)。其中自体动静脉内瘘患者中血栓的发生率为13.86%、血管瘤样扩张12.23%、吻合口狭窄2.17%、动脉窃血综合征1.63%、感染0.54%、静脉高压0.27%。肘部内瘘组血管瘤样扩张的发生率(66.67%)明显高于其在腕部内瘘(9.43%)组的发生率(?2=52.26,P<0.01);其它并发症的发生率,1～3年的内瘘通畅率以及透析充分性在两组之间无显著性差异。所有患者中没有出现高容量性心力衰竭。结论对维持性血液透析患者可首选腕部桡动脉-头静脉内瘘,当通路失败时,肘部内瘘可作为第二选择。
Objective Investigate the use of vascular access in maintenance hemodialysis （MHD） patients and the complications of native arteriovenous fistulas （NAVFs） in our single center. Methods Patients （n=376） were recruited in our study, 350 of them had wrist NAVFs （wrist group）,and 18 of them had elbow NAVFs （elbow group）. We evaluated the complications associated with NAVFs between these 2 groups. All statistical analyses were performed with SPSS software package, P 0.05 was assumed to be statistically significant. Results We found 93.09% （350/376） of patients had wrist NAVFs, followed by elbow NAVFs 4.79% （18/376）, while 1.33% （5/376） had graft AVFs and only 0.80% （3/376） of patients depended on a cuff catheter. The most frequent complications seen in our patients were thrombosis （13.86%）, followed by aneurysm （12.23%）, anastomotic stenosis （2.17%）; arterial steal syndrome （1.63%）; infection （0.54%）; and venous hypertension （0.27%）. Aneurysm was more common in the elbow group （66.67%） than in the wrist group （9.43%） （？=52.26,P0.01）,there were no differences in other complications,patency rate during 1～3 years and Kt/V between 2 groups. We did not find high-output cardiac failure related to NAVFs in our patients. Conclusion We think the wrist radiocephalic NAVF is the first choice for MHD patients; an elbow NAVF is a reasonable alternative for MHD access when a radiocephalic NAVF is not possible.
出处
《中国血液净化》
2011年第10期531-534,共4页
Chinese Journal of Blood Purification
