中国血液净化

中国血液净化 ›› 2013, Vol. 12 ›› Issue (05): 247-250.doi: 10.3969/j.issn.1671-4091.2013.05.00

• 临床研究 • 上一篇    下一篇

小儿血液透析动静脉内瘘建立的临床方法改进探讨

张宏涛1,赵显国2   

  1. 1. 河南省人民医院
    2. 郑州大学第一附属医院血液净化中心
  • 收稿日期:2012-12-10 修回日期:2013-02-14 出版日期:2013-05-12 发布日期:2013-07-01
  • 通讯作者: 赵显国 E-mail:zhaoxianguo8888@yahoo.com.cn
  • 基金资助:
    郑州大学青年基金

Arteriovenous Fistula Creation in Pediatric hemodialysis Patients

  • Received:2012-12-10 Revised:2013-02-14 Online:2013-05-12 Published:2013-07-01
  • Supported by:
    the Youth Foundation of Zhengzhou University

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摘要： 目的 探讨小儿血液透析动静脉内瘘建立的临床方法。方法 收集郑州大学第一附属医院2006年1月-2012年1月19名以动静脉内瘘作为永久性血管通路的患儿，其中男12例，女7例，有16例是以血液透析作为首选的肾脏替代治疗，3例为腹膜透析转为血液透析。观察患儿的动静脉内瘘的使用时间、成熟时间、内瘘的并发症及转归情况。结果 19例患儿共做31次手术（包括初始手术和再次手术），其中左前臂手术占21/31（67.7%），右前臂手术占7/31（22.6%），上臂手术占3/31（9.6%）。初始失败率是22.6%（7/31），剩余的77.4%（24/31）有功能的动静脉内瘘并发症中：血栓形成4/24（16.7%）， 狭窄占1/24（4.2%）， 假性动脉瘤占1/24（4.2%），高输出量占1/24（4.2%） ，静脉性高血压1/24（4.2%），需要血管重建或缩窄术。制作内瘘时平均年龄为7-17岁（12.21±3.17），平均体重为31.16±9.85Kg（16.7-45.4）,动静脉内瘘平均成熟时间9.84±5.6（4-25）周，内瘘的平均使用时间为18.95±17.32（3-64）个月。结论 良好的团队协作及适时的显微技术的应用可以提高小儿动静脉内瘘的成功率及使用时间。

关键词: 小儿血液透析, 动静脉内瘘建立

Abstract: Objective The aim of the study was to report our experience with arteriovenous fistulas (AVFs) in children and adolescents with end-stage renal disease (ESRD) on hemodialysis(HD).Assess the complication rates of and reasons for access failure in a group of children on HD Methods This was a retrospective cohort study to assess HD vascular access type, complications and causes of failure in children aged less than 18 years, who started HD during the 2006.1-2012.1 period. 19 children (7 females, 12 males) with ESRD received HD treatment. Hemodialysis was an initial renal replacement therapy in 16 out of the 19 children. Results 31 accesses were studied in 19 patients.A total of 21/31 (67.7%) of the AVFs were placed in the left forearm, 7/31 (22.6%) of them in the right forearm,and3/31 (9.6%) in the cubital fossa. AVF primary failure was detected in 22.6% of the fistulas. The complications of the remaining 77.4% (24/31) of the functionalAVFs were thrombosis in 4/24 (16.7%),stenosis in 1/24 (4.2%), aneurysm formation in 1/24(4.2%),High output in 1/24 (4.2%),venous hypertension in 1/24 (4.2%),The main cause of failure of the functioning AVFs was thrombosis (84%). Patients` mean age at AVF creation was 12.21±3.17 years（7-17 years）. Mean weight was 31.16±9.85Kg（16.7-45.4 Kg） The mean time from the construction of the AVF to its usage for hemodialysis was9.84±5.6weeks （4-25weeks）.The mean patency of the AVF was 18.95±17.32months （3-64 months）. Conclusions AVF usage rates and longterm patency rates can be quite high with proper vascular access team and microsurgery in gaining paediatric vascular access. Keywords: Pediatric hemodialysis Arteriovenous fistula construction

Key words: Pediatric hemodialysis, Arteriovenous fistula construction