中国血液净化

中国血液净化 ›› 2019, Vol. 18 ›› Issue (05): 335-338.doi: 10.3969/j.issn.1671-4091.2019.05.013

• 血管通路 • 上一篇    下一篇

人工血管内瘘自体静脉近静脉吻合口狭窄术前影响因素分析

温静1,杨涛1,詹申1,王玉柱1   

  1. 1. 北京市海淀医院(北京大学第三医院海淀院区)肾内科
  • 收稿日期:2019-02-13 修回日期:2018-11-02 出版日期:2019-05-12 发布日期:2019-05-15
  • 通讯作者: 王玉柱 wyz4417@126.com E-mail:wenjing0620@foxmail.com

Analysis of preoperative factors for vein anastomotic stenosis of arteriovenous graft fistula

  • Received:2019-02-13 Revised:2018-11-02 Online:2019-05-12 Published:2019-05-15

PDF

860

摘要： 【摘要】目的观察终末期肾病患者人工血管动静脉内瘘通畅情况，探究人工血管自体静脉近静脉吻合口狭窄的术前影响因素。方法选择2016 年在北京市海淀医院肾内科建立人工血管动静脉内瘘的138 例患者，收集临床资料并进行术后内瘘复查和随访，统计术后初级通畅率、初级辅助通畅率、次级通畅率，对人工血管内瘘自体静脉近静脉吻合口狭窄组和非狭窄组的术前资料进行分析，以确定狭窄发生的术前影响因素。结果人工血管动静脉内瘘术后6、12 个月初级通畅率分别为81.1%、52.1%，初级辅助通畅率为88.1%、64.2%，次级通畅率为95.7%、91.0%；Cox 多因素回归分析显示，吸烟(HR:2.713, 95% CI:1.324～5.56,P=0.006)是人工血管内瘘自体静脉近静脉吻合口狭窄术前独立危险因素，而使用抗血小板药物(HR:0.242,95% CI:0.102～0.572,P=0.001)是其独立保护性因素。结论人工血管动静脉内瘘手术患者经过积极处理可获得较好的次级通畅率。吸烟是人工血管内瘘自体静脉近静脉吻合口狭窄的危险因素，而抗血小板药物的使用是内瘘通畅的保护性因素。

关键词: 人工血管, 动静脉内瘘, 狭窄, 血液透析

Abstract: 【Abstract】Objective To investigate the patency and the preoperative factors for vein anastomotic stenosis of arteriovenous graft (AVG) fistulas in end-stage renal disease patients. Method A total of 138 cases treated with AVG fistula operation at the Renal Department of Haidian Hospital in 2016 were enrolled in this study. Their clinical data were collected. They were followed up after the operation to investigate their primary patency rate, assisted primary patency rate and secondary patency rate. The preoperative factors for vein anastomotic stenosis were identified through the analyses of preoperative clinical data of the patients with vein anastomotic stenosis and those without vein anastomotic stenosis. Result After the operation for 6 months, the primary patency, assisted primary patency and secondary patency rates were 81.1%, 88.1% and 95.7%, respectively. After the operation for one year, the primary patency, assisted primary patency and secondary patency rates were 52.1% , 64.2% and 91.0% , respectively. Cox multivariate regression analysis showed that smoking (HR: 2.713, 95% CI: 1.324～5.56, P=0.006) was an independent risk factor and antiplatelet therapy (HR: 0.242, 95% CI: 0.102～0.572, P=0.001)) was an independent protective factor for vein anastomotic stenosis of AVG fistulas. Conclusion The secondary patency rate of AVG fistulas was acceptable after interventions. Smoking was a risk factor and antiplatelet therapy was a protective factor for vein anastomotic stenosis of AVG fistulas.

Key words: Arteriovenous graft, Arteriovenous fistula, Stenosis, Hemodialysis