两种自体动静脉瘘术式在老年血液透析患者中的应用观察与分析

doi:10.3969/j.issn.1009-976X.2020.04.022

摘要/Abstract

摘要： 目的观察和分析老年血液透析患者自体动静脉内瘘（AVF）的应用。方法收集北京大学深圳医院手显微外科自2012年6月到2018年6月期间收治的血液透析患者的临床资料。按血管通路类型分为2组：头静脉-桡动脉AVF（桡-头AVF组,n=161）、尺动脉-贵要静脉AVF（尺-贵要AVF组,n=32）。通过查询住院病历、门诊记录、随访记录,通过血管通路（AV）前后的彩色多普勒超声（DUS）等检查,观察和记录记录的患者内瘘成熟、功能障碍、管腔狭窄等信息。结果在纳入的193例中,92例（47.7%）在AV建立前使用中心静脉插管（CVC）进行血液透析,平均使用时间为134.8±66.2 d。两组在年龄、性别、血压、实验室检查、ESRD病因和伴发疾病方面没有显著差异;14例（7.4%）放弃VA,21例（10.8%）因各种原因死亡;28例（14.7%）因静脉瘘管失功不能使用VA,其中13例（6.8%）接受二次或改良手术。桡-头AVF组和尺-贵要AVF组在上述数据间的差异没有统计学意义。AVF术后并发症分别为血栓、血肿形成、感染、动脉瘤形成、管腔狭窄和静脉瘤样扩张,组间差异无统计学意义。老年患者在建立AV后的各种原因的死亡以及导致AVF失败或弃用的相关因素涉及到年龄、外周血管疾病、桡动脉直径有关,但与手术方式选择无关。结论 AVF安全有效,并发症低;医生可根据经验和患者具体情况选择手术方式。

关键词: 瘘管失功, 老年., 自体动静脉内瘘

Abstract: Objective To observe and analyze the application of autogenous arteriovenous fistula （AVF） in elderly hemodialysis patients. Methods The clinical data of elderly patients with hemodialysis treated with in hand microsurgery of Peking University Shenzhen hospital from June 2012 to June 2018 were collected. According to the type of vascular access, they were divided into two groups： radio cephalic arteriovenous fistula（RC-AVF group, n=161） andulnar-basilar arteriovenous fistula （UB-AVF group, n=32）. By inquiring the inpatient medical records, outpatient records, follow-up records, and color Doppler ultrasound （DUS） before and after vascular access （AV）, we observed and recorded the information of fistula maturity, dysfunction, lumen stenosis. Results Of 176 cases, 92 （47.7%） used central venous catheterization （CVC） for hemodialysis before AV, with an average duration of 134.8±66.2 days. There were no significant differences in age, gender, blood pressure, laboratory examination, etiology of ESRD and associated diseases between the two groups; 14 cases （7.4%） gave up VA, 21 cases （10.8%） died due to various reasons; 28 cases （14.7%） could not use VA due to venous fistula dysfunction, and 13cases （6.8%） underwent secondary or modified operation. There was no significant difference between RC-AVF group and UB-AVF group. The postoperative complications of AVF were thrombosis, hematoma formation, infection, aneurysmal formation, luminal stenosis and venous aneurysmal dilation. Age, peripheral vascular disease and radial artery diameter are related to the death of elderly patients after establishing AV and the related factors leading to failure or abandonment of AVF were related to age, peripheral vascular disease and radial artery diameter. Conclusion AVF was safe and effective with low complications. Doctors can choose the operation method according to the experience and the specific situation of patients.

Key words: maturation failure, elderly, autogenous arteriovenous fistula

中图分类号:

R654.3

彭艳斌, 褚云峰, 陈仲, 万圣祥, 肖颖峰. 两种自体动静脉瘘术式在老年血液透析患者中的应用观察与分析[J]. 岭南现代临床外科, 2020, 20(04): 503-506.

PENG Yan-bin, CHU Yun-feng, CHEN Zhong, WAN Sheng-xiang, XIAO Ying-feng. Observation and analysis of two kinds of autogenous arteriovenous fistula in elderly hemodialysis patients[J]. Lingnan Modern Clinics in Surgery, 2020, 20(04): 503-506.

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