中国血液净化

›› 2004, Vol. 3 ›› Issue (1): 5-8.

• 论著 • 上一篇    下一篇

手鼻烟窝部动静脉内瘘在血液透析中的临床应用研究

沈东波 李冰贤 陈凤娇 谢广兰 周雪珍 孙爱丽   

  1. 519000 珠海,广东省珠海市人民咏院血液净化中心
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2004-01-19 发布日期:2004-01-19

  • Received:1900-01-01 Revised:1900-01-01 Online:2004-01-19 Published:2004-01-19

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摘要： 目的 探讨鼻烟窝动静脉内瘘在维持性血液透析中的临床应用。 方法 采用显微外科技术对
169例慢性肾功能衰竭血液透析患者行直接动静脉内瘘术，分别为鼻烟窝部83例，前臂远端腕部86例（ Cimino瘘），比较两组内瘘成熟时间、血流量、近远期通畅率及并发症等。结果 两组在内瘘成熟时间、血流量上无显著差异( P>0.05)。鼻烟窝瘘和 Cimino瘘的通畅率分别为：4周96.4%和95.3%（P>0.05），1年为92.6%和80.7% (P<0.05)，2年为86.7%和72.2% (P<0.05)，3年为81.4%和63.0%(P<0.05)。鼻烟窝瘘及Cimino瘘栓塞发生率分别为18.6% 和 37.0% ( P<0.05)，动脉瘤发生率分别为14.3% 和30.1%(P<0.05)。 结论 鼻烟窝动静脉内瘘制作简便、远期通畅率高、并发症少，保留了近端血管以备重建内瘘，是血液透析最佳的永久性血管通路。

关键词: 鼻烟窝动静脉内瘘, 血液透析, 慢性肾功能不全, 血管通路

Abstract:

Objective To evaluate the clinical application of snuffbox arteriovenous fistula(SAF) in maintenance hemodialysis. Methods One hundred and sixty-nine direct internal arteriovenous fistulas(DIAF) for hemodialysis patients with chronic renal failure(CRF) were established under microsurgery, 83 being at anatomical snuffbox and 86 at wrist of distal forearm(Cimino fistula, CF). The time of mature, the volume of blood flow, the patency rate of short-term and long-term, and complications in DIAF were observed. Results There were no significant differences in two groups of SAF and CF on the time of mature and the volume of blood flow ( P>0.05). The patency rates in SAF and CF were 96.4% vs 95.3% in four weeks( P>0.05), 92.6% vs 80.7% in one year ( P < 0.05), 86.7% vs 72.2% in two year ( P<0.05) and 81.4% vs 63.0% in three year ( P<0.05). The incidence rates of thrombosis in SAF and CF were 18.6% and 37.0% respectively ( P<0.05), and that of aneurysm were 14.3% and 30.1% respectively ( P<0.05). Conclusions Performing easily, having a better long-term patency rate and fewer complications, sparing the proximal vessels for reoperation if necessary, the snuffbox arteriovenous fistula is the most advisable permanent vascular access in hemodialysis. 

Key words: Hemodialysis, Chronic renal failure, Vascular access

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