单中心动静脉内瘘手术临床分析

摘要

Objective Toanalyzetheclinicaldatafromhemodialysispatientssubjecttoarterio-venous fistulas (AVF)operations in a single center,to retrospectively define the establishment and protectionofarteriovenousfistulas.Methods Thestudyenrolled490hemodialysispatientsafterfistu-laoperationsbetweenJanuary2012andMarch2014intheFirstHospitalofWuhan.Results Thepri-mary diseases of the 490 patients screened were mainly chronic nephritis (49.6%), diabetes (17.6%),hypertension (12.9%).37.4% of the patients completed the operation before the first di-alysis,and the vast majority of the patients had reached CKD 5 level.Seventy-seven (15.7%)patients had successful AVF construction with the conventional side,without affecting their daily life during the follow-up.The diameters of the artery and vein of patients in the first AVF were (2.25 ±0.47) mm and 2.08±0.49 mm respectively,significantly smaller than those of the patients undergoing re-peated AVF surgery [(3.10±0.92)mm and (3.65±1.58)mm respectively,P<0.05].The success rate of AVF initial construction or reconstruction was 98.5% (447/454).Furthermore,there was no significant difference in patency rate between diabetic and non-diabetic group.Elderly patients had de-creasedone-yearpatencyrateascomparedwiththeyoungpatients.Conclusions (1)Thestarttiming of fistula operation for uremic patients is usually late;(2)Conventional side operation has no signifi-cant influence on patient's daily lives;(3)No remarkable difference in operation success rate and pa-tency rate exists between diabetic and non-diabetic groups;(4)Long-term patency rate for elderly pa-tients? is usually on the lower side.%目的分析行动静脉内瘘手术的血液透析患者的临床资料,以期对动静脉内瘘的建立及保护提供理论依据。方法收集2012年1月1日至2014年3月31日在武汉市第一医院行动静脉内瘘手术的490例患者病例资料进行回顾性统计分析。结果手术患者原发病以慢性肾球肾炎243例(占49.6%)、糖尿病86例(占17.6%)、高血压63例(占12.9%)为主。在开始透析前即完成动静脉内瘘的患者138例(占37.4%),绝大多数患者已达到 CKD 5期水平。惯用手行内瘘手术者77例(占15.7%),术后随诊调查发现无一例患者反映惯用侧手术后影响日常生活。首次手术患者中动脉直径(2.25±0.47)mm,静脉直径(2.08±0.49)mm,多次手术者动脉直径(3.10±0.92)mm,静脉直径(3.65±1.58)mm。首次手术者动静脉内径均较第二次及以上者为小(P<0.05)。新建及重建内瘘患者即刻成功率为98.5%(447/454),糖尿病组和非糖尿病组通畅率无统计学差异。老年患者1年通畅率低于中青年患者。结论①尿毒症患者开始内瘘手术时机较晚；②惯用侧手术对患者日常生活无明显影响；③糖尿病患者和非糖尿病患者手术成功率及通畅率无统计学差异；④老年患者内瘘长期通畅率偏低。