新型人造血管移植物内瘘首次穿刺时间对通畅率及并发症影响的系统评价

摘要

Objective The aim of this review is to summarize the data in the literature about the first puncture time,patency rate and complications in patients using the novel arteriovenous gifts (AVG) for arteriovenous fistula.Methods Electronic databases including PubMed,MedLine,Cochrane Library (Issue 7,2017),Embase and CNKI before July 2017 were searched for studies about the use of early cannulation grafts for dialysis.According to the inclusion and exclusion criteria,related cohort studies were collected,and data were extracted and cross-checked by two reviewers.The primary outcome in this study was primary patency (PP) rate and secondary patency (SP) rate.The secondary outcome was complication rate of AVGs including thrombosis,hematoma,pseudoaneurysm,infection and steal blood syndrome.Results A total of 20 studies involving 1,230 cases treated with AVGs were included in this systematic review.Four types of AVGs including FlixeneTM,VectraTM,AcusealTM and AvfloTM were used.Most of the AVGs could be used for puncture after the surgery for 3 days,and some of them could be used after the surgery for 48 hours or even for 24 hours.There were no significance differences in patency rate and complications as compared with those using the traditional ePTFE AVG.AcusealTM AVG had the advantage of less thrombosis,and AvfloTM AVG had less infections.Conclusion This review shows that the novel AVGs have the advantages of early puncture within 3 days without impacts on primary patency rates,secondary patency rates and complications.%目的 系统性评价新型材料人造血管移植物内瘘首次穿刺时间对其通畅率及并发症的影响. 方法 计算机检索PubMed、MedLine、Cochran Library (2017年第7期)、Embase和CNKI数据库,查找有关人造血管移植物内瘘术后首次穿刺时间与内瘘预后关系的队列研究,检索时限均从建库到2017年7月20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,填写制订好的数据提取表.主要的结局指标是初始通畅率(primary patency,PP)和累积通畅率(secondary patency,SP);次要的结局指标是人造血管移植物内瘘(arteriovenous graft,AVG)的主要并发症包括:血栓、血清肿、感染、假性动脉瘤、盗血综合征. 结果 本系统评价共纳入20个队列研究,合计1230例AVG.新型人造血管移植物内瘘根据人造血管材料的不同主要有FlixeneTM、VeetraTM、AcusealTM和AvfloTM共4类,这些新型人造血管移植物内瘘均为“即穿型”,即支持术后3天左右的安全穿刺,并且内瘘的通畅率和并发症与传统材料即可拉伸型聚四氟乙烯(expanded polytetrafluoroetbylene,ePTFE) AVG相比无显著差别.在AVG术后并发症方面,AcusealTMAVG的血栓形成风险有降低趋势,而AvfloTMAVG的感染发生风险有降低的趋势,这些均与它们独特设计结构可能有关. 结论 新型材料人造血管移植物内瘘可于术后3天内早期穿刺使用,早穿刺对其初始通畅率、累积通畅率和并发症发生率无影响.