摘要
目的比较前臂尺动脉-贵要静脉内瘘(观察组)与桡动脉-头静脉标准内瘘(对照组)的应用效果,从而探讨其在终末肾病患者长期透析治疗中的应用价值。方法回顾性分析2018年1月至2019年5月在江苏大学附属医院肾内科行前臂自体动静脉内瘘的154例患者(观察组10例、对照组144例)的临床资料,术后随访2年,统计分析2种手术方式在成熟时间、感染率、并发症发生率和1、6、12、24个月初级通畅率及次级通畅率等数据上的差异。结果两组患者在原发糖尿病肾病、年龄、性别构成及外周血管疾病等方面差异均无统计学意义(P>0.05),所有患者内瘘手术成功,术中无重要血管神经损伤、大出血等情况发生,术后内瘘通畅,未见内瘘感染、肿胀手、内瘘肢体窃血及心功能不全等。观察组平均成熟时间(37.00±13.40)d,对照组平均成熟时间为(30.00±2.00)d,两组平均成熟时间差异有统计学意义(t=6.227,P<0.001)。并发症方面:观察组1例假性动脉瘤,对照组瘤样扩张1例。初级通畅率:观察组1、6、12、24个月初级通畅率分别为70%、60%、60%、60%,对照组12个月及24个月初级通畅率分别为98.61%、96.13%、92.36%、88.19%。两组初级通畅率差异有统计学意义(χ^(2)=9.902,P=0.002)。次级通畅率:观察组1个月80%,6个月80%,1年70%,2年70%;对照组1个月98.61%,6个月97.22%,1年96.53%,2年96.53%。两组次级通畅率差异有统计学意义(χ^(2)=21.32,P<0.001)。结论前臂尺动脉-贵要静脉内瘘手术感染率和并发症发生率低,但较前臂桡动脉-头静脉内瘘标准内瘘有较低的1、6、12、24个月初级通畅率及次级通畅率,且成熟时间相对长,一定条件下可作为备选方案。
Objective By comparing the application effects of ulnar-basilic arteriovenous fistula(observation group)and radial-cephalic arteriovenous fistula(control group),explore its application value in the long-term dialysis treatment of patients with end-stage renal disease.Methods Retrospective analysis was performed on the clinical data of 154 patients who underwent arteriovenous fistula in the Department of Nephrology of the Affiliated Hospital of Jiangsu University from January 2018 to May 2019(10 cases of ulnar-basilic arteriovenous fistula and144 cases of radial-cephalic arteriovenous fistula).The patients were followed up for 2 years.The differences of maturation time,infection rate,complication rate,primary patency rate and secondary patency rate as of 1,6,12 and 24 months between the two surgical methods were analyzed statistically.Results There were no significant differences in primary diabetic nephropathy,age,gender composition,and peripheral vascular disease between the two groups(P>0.05).All patients had successful internal fistula surgery,and there were no major vascular and nerve damage or hemorrhage during the operation.The internal fistula was unobstructed,and the blood vessel murmur was clear.There were no internal fistula infections,swollen hands,internal fistula limbs stealing blood,and cardiac insufficiency in the postoperative follow-up.The average maturity time of the observation group was(37.00±13.40)days,and the average maturity time of the control group was(30.00±2.00)days.There was a statistically significant difference in the average maturity time between the two groups(t=6.227,P<0.001).In regard of complications,there was 1 case of pseudoaneurysm in the observation group while 1 case of tumor-like dilatation occurred in the control group.The primary patency rates in the observation group as of 1,6,12 and 24 months was respectively 70%,60%,60%,60%.While in the control group they were respectively 98.61%,96.13%,92.36%,88.19%.The primary patency rate was significantly different between the two groups(χ^(2)=9.902,P=0.002).The secondary patency rates in the observation group as of 1,6,12 and 24 months were respectively80%,80%,70%,and 70%.In the observation group,the secondary patency rate at 1,6,12 and 24 months was 80%,80%,70%,70%,respectively,while in the control group,the secondary patency rate at 1,6,12 and 24 months was 98.61%,97.22%,96.53%,96.53%.There was significant difference in secondary patency between the two groups(χ^(2)=21.32,P<0.001).Conclusion The surgical infection rate and complication rate of ulnar-basilic arteriovenous fistula were low.But compared with the radial-cephalic arteriovenous fistula,the primary patency rate and secondary patency rate of 1 month,6 months,12 months and 24 months were lower,and the maturation time was relatively longer.Therefore,it could be used as a secondary option under certain conditions.
作者
吴其顺
何建强
王泰娜
夏炎
余姝
王琳
WU Qishun;HE Jianqiang;WANG Taina;XIA Yan;YU Shu;WANG Lin(Department of Nephrology,Affiliated Hospital of Jiangsu University,Zhenjiang 212000,China;不详)
出处
《实用医学杂志》
CAS
北大核心
2022年第1期7-11,17,共6页
The Journal of Practical Medicine
基金
国家自然科学基金资助项目(青年)(编号:81801664)。
