影响动静脉内瘘成熟的因素探讨

目的了解内瘘手术后存活情况以及影响内瘘成熟的因素。方法前瞻性研究390例患者内瘘手术动静脉直径和动脉开窗长度、动脉增厚、原发病等因素对内瘘成熟的影响以及并发症情况。结果390例患者共计413例次动静脉内瘘吻合手术,其中370次初次瘘,再次瘘43例次。手术共有43例次（10.4%）内瘘失败。包括术后未成熟的共34例次,另外有8例次是在使用一定时间（6～12个月）后失功能。其中22例是经彩色多普勒证实为血栓形成。内瘘失败与年龄、性别、动静脉内径、以及吻合部位和术后是否抗凝无关,与糖尿病和动脉增厚,动脉吻合口大小有关。糖尿病（OR=2.72,95%CI：1.18-6.28,P=0.019）及吻合口大小（OR=0.12,95%CI：0.02-0.62,P=0.011）是内瘘失败的独立危险因素。结论动静脉内瘘失败的发生率为10.4%。血栓形成是内瘘失败的主要原因。动静脉内瘘失败的主要危险因素是内瘘吻合口直径及糖尿病。

Research on the factors affecting the maturation of arteriovenous fistula

Objective To investigate the factors affecting the maturation of arteriovenous fistula (AVF) and its complications. Methods A total of 390 cases with end stage renal disease (ESRD) and AVF operation were prospectively studied. Factors relating to the maturation of AVF and its complications, such as primary cause of ESRD, diameter of the artery and vein, and anastomosis size of AVE were analyzed during the follow-up period of more than four months. Results A total of 413 AVF operations were performed in the 390 patients,of which 370 were the operation for the first time, and 43 were the operation of second time. The operation failed in 43 cases (10.4%), due to immaturation of the AVF in 34 cases and dysfunction of the AVF after use for 6-12 months in 8 cases. Of the 43 cases, ultrasound Doppler examination revealed thrombosis in the AVF in 22 cases. AVF failure correlated with diabetes mellitus, arterial thickening, and anastomosis size of AVE but unrelated with age, sex, diameter of artery and vein, anastomosis site and postoperative anticoagulation therapy.Diabetes mellitus (OR=2.72, 95% CI=1.18-6.28, P=0.019) and anastomosis size (OR=0.12, 95% CI=0.02-0.62, P=0.011) were the independent risk factors for the fistula failure. Conclusion Fistula failure occurred in 10.4% patients. The major cause of fistula failure was thrombosis. Diabetes mellitus and anastomosis size were the independent risk factors for the fistula failure.