摘要
目的通过总结肾内科近两年32例血液透析患者的临床资料,探讨导致自体动静脉内瘘手术失败的原因。方法选取自2010年2月-2012年2月于大连医科大学附属第二医院住院的行前臂动静脉内瘘失败的终末期肾病患者32例。收集患者术前晨起空腹血红蛋白(Hb)、胆固醇(CHOL)、纤维蛋白原(Fib)、甲状旁腺素(PTH)、血糖以及术前血压状况,同时术前行上肢血管超声,检测患者桡动脉和头静脉内径。于同期随机选取66例本院首次行前臂动静脉内瘘手术成功的患者为对照组,收集其相应的上述指标,结果行统计学分析。结果①实验组头静脉及桡动脉内径明显小于对照组头静脉和桡动脉内径。头静脉和桡动脉内径是内瘘失败的重要因素,内径越小,失败的危险性越大。②实验组PTH显著高于对照组,经成组t检验其差异有统计学意义。经Logistic回归分析认为PTH是动静脉内瘘失败的危险因素。③两组术前收缩压、舒张压经Logistic回归分析认为术前收缩压和舒张压与动静脉内瘘手术的成败有关,血压越低,内瘘越易失败。结论导致自体动静脉内瘘失败的主要原因是头静脉和桡动脉内径,内径越小,闭塞的几率越大。血压、PTH也是影响内瘘成功率的重要因素。
Objective To investigate the risk factors causing the of occlusion of arteriovenous fistula. Methods We collected the data of 32 uremic patients who were failing in surgically constructed arteriovenous fistulas and 66 patients who were successful in the surgery from Feb 2010 to Feb 2012 ,including blood hemoglobin（Hb） ,cholesterol（CHOL） fibrinogen（Fib） ,parathyroid hormone （ PTH）, fasting blood glucose and pressure before the operation. In the meantime, we detected diameter of the radial artery and cephalic vein by using upper limb vascular uhrasound. 66 successful cases in the same period were as control. The result of the two groups was compared and statistical analyzed. Results ①The cephalic vein and radial artery diameter of the experimental group was significantly less than those of the control group. The diameters of the cephalic vein and the radial artery were risk factors of fistula failure. ②the levels of PTH in experimental group were significantly higher than those in the control group（P 〈 0.05）. Logistic regression analysis showed that PTH was the risk factors of fistula failure. ③ The preoperative blood pressure（ systolic pressure and diastolic pressure） was positive related to the failure of fistula establishment. Conclusion The smaller diameters of cephalic vein and radial artery commonly lead to the occlusion of arteriovenous fistula. The blood pressure and PTH also play an important role on the successful fistula.
出处
《中华全科医学》
2013年第5期694-695,756,共3页
Chinese Journal of General Practice
关键词
动静脉内瘘
头静脉
桡动脉
血压
PTH
尿毒症
Arteriovenous fistula
Cephalic vein
Radial artery
Blood pressure
Parathyroid hormone
Uremia
