摘要
目的探讨影响血液透析患者细径血管成功建立动静脉内瘘(artetiovenous fistula,AVF)至成熟使用主要因素。方法选取2021年7月—2023年7月在广西壮族自治区南宁市第二人民医院肾内科术前通过血管B超检查提示动静脉直径<2 mm的终末期肾病90例患者作为研究对象,采用前瞻性的研究,根据随访中AVF的成功情况分为AVF成功组(n=75)与AVF失败组(n=15),比较2组术前血红蛋白、甲状旁腺素、平均动脉压、动静脉管径、头静脉扩张度、静脉距皮距离、动脉是否严重钙化、动脉血流量等;术中观察动脉有无粥样斑块、动脉切口长度、动静脉夹角;术后6周随访监测AVF动静脉血流量和管径,统计各组AVF成熟的成功率,通过相关分析提出细径血管建立AVF成功的影响因素。结果AVF成熟的成功率为83.33%(75/90),其中术前B超检查血管直径<1.0 mm的成功率为76.67%(23/30),血管直径1.0~1.4 mm的成功率为83.33%(25/30),血管直径1.5~1.9 mm的成功率为90.00%(27/30)。单因素分析结果提示,2组的头静脉扩张度(P=0.001)、静脉距皮距离(P=0.023)、头静脉管径(P=0.002)、头静脉血流(P=0.036)、术中有无动脉粥样斑块(P<0.011)、术后6周头静脉血流(P<0.001)、术后6周桡动脉血流(P=0.001)、术后6周肱动脉血流比较(P=0.005),差异有统计学意义;多因素分析结果提示,头静脉管径(β=0.912,OR=2.490,95%CI=1.255~4.939)、头静脉扩张度(β=0.152,OR=1.164,95%CI=1.046~1.296)是AVF成熟不良的相关危险因素(P<0.05)。结论对于细径血管的终末期肾病患者,可选择行AVF术,其AVF成熟率较高,头静脉管径和头静脉扩张度是影响细径血管建立AVF成功的重要因素。
Objective To explore the main factors affecting the successful establishment of arteriovenous fistula with small diameter vessels to mature use.Methods 90 cases of patients with end-stage renal disease were chosen as research subjects.Those patients were hospitalized in the Second Nanning People's Hospital,Guangxi Zhuang Autonomous Region from July 2021 to July 2023.Their arteriovenous diameter was<2 mm,which was inspected by B-mode ultrasonography before renal surgery.Prospective studies were adopted.Those patients were based on the size of vessel diameter and divided into two groups,namely Autogenous arteriovenous fistula(artetiovenous fistula,AVF)successful group(n=75)and failure group(n=15).Before the surgery,each group was compared in the following factors:average arterial pressure,arteriovenous diameter,dilatability of the internal diameter of the vein,distance from the skin of the vein,whether the artery was severely calcified,arterial blood flow.In the following six weeks after the surgery,those patients'arteriovenous blood flow and tube diameter of internal fistula have been continually monitored.the success rate of arteriovenous fistula maturation in each group were calculated.Those results were analyzed and affecting factors,lead to the successful establishment of arteriovenous fistula,were put forwarded.Results Among 90 cases of patients with end-stage renal disease,the successful rate of mature arteriovenous fistula was reached to 83.33%(75/90).Among it,the blood vessel diameter was tested less than 1.0mm before the surgery.Its successful rate was reached to 76.67%(23/30).The blood vessel diameter 1.0-1.4 mm,its successful rate is reached to 83.33%(25/30).The blood vessel diameter 1.5-1.9 mm,its successful rate is reached to 90.00%(27/30).The monofactor analysis shows that the two groups'cephalic vein dilation(P=0.001),venous talar distance(P=0.023),cephalic vein distance(P=0.002),cephalic venous flow(P=0.036),intraoperative atherosclerotic plaque(P=0.011),cephalic venous flow after six weeks of surgery(P<0.001),radial artery blood flow 6 weeks after surgery(P<0.001),brachial artery blood flow after 6 weeks of surgery comparism(P=0.005).The differences had significance for calculating(P<0.05).The multivariate analysis results shows that cephalic vein (B=0.912,OR=2.490,95%CI=1.255-4.939),cephalic vein dilation(B=0.152,OR=1.164,95%CI=1.046-1.296)was related dangerous factors resulted in immature internal arteriovenous fistula(P<0.05).Conclusion For patients with end-stage renal disease with small diameter vessels,AVF can be selected,and the AVF maturity rate is higher.The cephalic vein distance and degree of expansion of cephalic vein dilation are the important factors affecting the success of establishing arteriovenous fistula.
作者
朱苓瑕
宁燕虹
赵志权
贺涤非
李绍兰
陈雪梅
ZHU Lingxia;NING Yanhong;ZHAO Zhiquan;HE Difei;LI Shaolan;CHEN Xuemei(Department of Nephrology,the Second Nanning People's Hospital,Guangxi Zhuang Autonomous Region,Nanning Guangxi 530000,China)
出处
《中国卫生标准管理》
2024年第22期97-101,共5页
China Health Standard Management
基金
广西壮族自治区卫生健康委员会自筹经费科研课题(Z20210067)。
关键词
动静脉内瘘
终末期肾病
细径血管
血液透析
内瘘成功
影响因素
arteriovenous fistula
end-stage renal disease
small blood vessels
hemodialysis
successful internal
fistula influence factor
