中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (02): 107-113.doi: 10.3969/j.issn.1671-4091.2018.02.008

• 血管通路 • 上一篇    下一篇

新建立自体动静脉内瘘首次穿刺时间对内瘘预后影响的系统评价和Meta 分析

王慧1,2,孙秀丽1,吴红梅1,殷娜1,冯国徵1,陈爱珍1,刘爱英1,侯国存1   

  1. 1. 包头市中心医院肾内科血液透析中心  2. 包头医学院
  • 收稿日期:2017-07-12 修回日期:2017-12-05 出版日期:2018-02-12 发布日期:2018-02-12
  • 通讯作者: 侯国存 houguocun2007@163.com E-mail:houguocun2007@aliyun.com

Influence of the first cannulation time for newly established arteriovenous fistula on vascular access failure: a systematic review and meta-analysis

  • Received:2017-07-12 Revised:2017-12-05 Online:2018-02-12 Published:2018-02-12

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摘要： 目的系统评价新建立的自体动静脉内瘘(arteriovenous Fistula，AVF)首次穿刺使用时间对AVF 远期预后的影响。方法计算机检索PubMed、MedLine、the Cochran Library(2017 年第6 期)、CNKI 等数据库，查找有关新建立的AVF 术后首次穿刺使用时间对其预后影响的队列研究，检索时限均从建库到2017 年6 月1 日。由2 位研究员按照纳入与排除标准独立筛选文献、提取资料并交叉核对和评价质量后，采用Stata 12.0 软件进行Meta 分析。结果系统评价共纳入9 个研究，合计5045 例AVF，AVF术后首次穿刺时间是影响内瘘预后的危险因素之一。Mete 分析纳入4 个研究，共计2450 例AVF，根据术后第1 次穿刺时间比较初始通畅率的变化：14 天内穿刺和14 天后穿刺比较，随访3 个月(RR=2.124，P=0.030)、12 个月(RR=2.172，P＜0.001)、18 个月(RR=2.276，P=0.003)、24 个月(RR=2.087，P=0.008)、36 个月(RR=2.093，P=0.337)以上差异均有统计学意义；30 天内穿刺和30 天后穿刺比较，在24 个月(RR=2.952，P＜0.001)和36 个月(RR=2.336，P＜0.001)差异有统计学意义，其余早期随访时间点无统计学差异；14 天内穿刺和15-30 天穿刺比较，在24 个月(RR=1.146，P=0.442)差异有统计学意义，其余早期随访时间点无统计学差异；15～30 天内穿刺与30 天后穿刺比较，在3 个月(RR=2.893，P=0.030)、24 个月(RR=2.834，P＜0.001)和36 个月(RR=2.232，P＜0.001)时有统计学意义，其余早期随访时间点无统计学差异。结论新建立的AVF 术后首次穿刺使用时间是影响其远期预后的重要危险因素之一。应避免AVF术后14 天内首次穿刺使用，有紧急透析指征可通过物理和超声检查充分评估AVF 已成熟情况下，可在AVF 术后14天以后进行首次穿刺使用。AVF 最佳成熟时间可能至少30 天。

关键词: 自体动静脉内瘘, 首次穿刺, 初始通畅率, 系统评价, Meta分析

Abstract: Objective To systematically review the influence of the first cannulation time for newly established arteriovenous fistula (AVF) on vascular access failure. Methods Databases including PubMed, Medline, the Cochrane Library (Issue 6, 2017) and CNKI were searched up to June 2017 to collect cohort studies about the influence of first cannulation time for newly established arteriovenous fistula on vascular access failure. According to the inclusion and exclusion criteria, the related cohort studies were screened, data were extracted and cross-checked, and quality of included studies was independently evaluated by two reviewers. Meta-analysis was then conducted using Stata 12.0 software. Results A total of 9 studies involving 5,045 AVFs were included to the systematic review, showing that the first cannulation time for newly established arteriovenous fistula is associated with fistula failure. Four studies involving 2,450 AVFs were finally included in our meta- analysis. When the primary patency rates were compared between patients with the first cannulation time within 14 days and those more than 14 days, the differences were statistically significant after 3 months(RR=2.124, P=0.030), after 12 months (RR=2.172, P＜0.001), after 18 months (RR=2.276, P=0.003), and after 24 months (RR=2.087, P=0.008), but without significance after 36 months (RR=2.093, P=0.337). When the primary patency rates were compared between patients with the first cannulation time within 30 days and those more than 30 days, the differences were statistically significant after 24 months (RR=2.952, P＜0.001) and after 36 months (RR=2.336, P＜0.001), but without significance at other time points of follow-up. When the primary patency rates were compared between patients with the first cannulation time within 14 days and those within 15～30 days, the difference was statistically significant after 24 months (RR=1.146, P=0.442), but without significance at other time points of follow-up. When the primary patency rates were compared between patients with the first cannulation time within 15～30 days and those more than 30 days, the differences were statistically significant after 3 months (RR=2.893, P=0.030), 24 months (RR=2.834, P＜0.001) and 36 months (RR=2.232, P＜0.001), but without significance at other time points of follow-up. Conclusions The first cannulation time of the newly established AVF was an important risk factor for long-term patency. Cannulation of AVF within 14 days should be avoided. Cannulation between 2 and 4 weeks was performed only at emergency condition, and the maturation degree of the fistula must be evaluated by physical and ultrasound examinations before cannulation. Maturation of AVF was completed after 30 days.

Key words: Arteriovenous fistula, First cannulation, Primary patency, Systematic review, Meta-analysis