维持性血液透析患者自体动静脉内瘘血流量的影响因素研究

目的 研究分析维持性血液透析患者自体动静脉内瘘血流量的影响因素。方法 回顾性分析2020年1月至2022年12月在本院行维持性血液透析患者共152例,按照透析时自体动静脉内瘘的血流量不同,将152例患者分为两组,其中观察组41例,为自体动静脉内瘘流量不足者,对照组111例,为自体动静脉内瘘流量充足者。结果 观察组患者的桡动脉、肱动脉血流量均明显小于对照组患者,而阻力指数、搏动指数均大于对照组患者（P<0.05）;无论吻合方式或吻合口位置的不同,观察组的吻合口内径均明显小于对照组（P<0.05）;通过多因素Logistic回归分析,结果显示,吻合口内径以及肱动脉血流量均是自体动静脉内瘘血流量不足的重要危险因素。结论 血流量是评估自体动静脉内瘘功能是否良好的重要指标,分析并了解影响血流量的相关影响因素,可以在早期进行及时有效的干预,进而维持充足血流量,本研究认为吻合口内径和肱动脉血流量均是影响自体动静脉内瘘血流量大小的独立危险因素。     

维持性血液透析患者动静脉内瘘血流量、透析中动脉压与内瘘功能的相关性

目的:探讨维持性血液透析(maintenance hemodialysis, MHD)患者动静脉内瘘血流量(arteriovenous fistula blood flow, AVFB)与透析中动脉压的相关性。方法:选取3家医院2016年1月至2019年1月利用动静脉内瘘行MHD的慢性肾衰竭患者150例作为研究对象,根...     

动静脉内瘘术用于血液透析的临床研究

目的探讨动静脉内瘘的手术方法并总结其临床效果。方法对慢性肾功能衰竭施行动静脉内瘘术985例，其中前臂动静脉内瘘术中，前臂动静脉703例，头静脉与桡动脉端-侧或端-端连续外翻吻合；肘部自体动静脉内瘘198例，头静脉、贵要静脉或肘正中静脉与肱动脉行端-侧连续外翻吻合；PTFE人造血管内瘘84例，前臂作“U”形皮下隧道，置入PTFE人造血管20—35cm，动脉端人造血管与肱动脉行端-侧吻合，静脉端与肱静脉、头静脉或贵要静脉采用端-端或端-侧吻合。结果术后瘘口均可扪及震颤或闻及血流杂音，术后1周内瘘口震颤消失52例，彩超发现瘘口狭窄，有血栓形成，行二次手术，重新吻合后均获成功。应用人造血管内瘘术后肢体肿胀较明显。内瘘3周后开始使用，首次穿刺透析血流量大于200ml／min，血液透析效果满意。结论前臂头静脉-桡动脉端．侧吻合是动静脉内瘘术的首选术式，吻合口径5mm较合适，人造血管内瘘对上肢血管条件差的患者，具有较好的效果。     

动静脉内瘘术用于血液透析的临床研究

自１９８５年１月～１９９６年３月为１２５６例慢性透析患者建立动静脉内瘘并成功地进行了血液透析，其中自体血管内瘘１１０１例（鼻烟窝动静脉内瘘５２６例，前臂动静脉内瘘５１２例，上臂动静脉内瘘３６例，下肢动静脉内瘘２７例），大隐静脉搭桥１５例，聚四氟乙烯人造血管（ＰＴＦＥ）搭桥动静脉内瘘１８例，人尸动脉搭桥动静脉内瘘１２２例。手术成功率１００％，１年通畅率９５．３％，３年通畅率８２．５％，５年通畅率７１．２％，１０年通畅率为４８．６％。就制作动静脉内瘘以及对国内外开展各种制作内瘘方法的临床评价和经验进行比较。     

利用超声多普勒观察动静脉内瘘血流变化

我院自１９９１年～１９９７年利用彩色Ｂ超及经颅多普勒对３４例血液透析患者在内瘘术前及其后进行动态观察，并结合临床进行探讨。资料与方法自１９９１年３月～１９９７年１１月，对行内瘘术患者３４例进行观察，其中男性１９例，女性１５例，年龄１８岁～５８岁，平均...     

92例动静脉内瘘术的治疗体会

对于尿毒症患者,需进行长期血液透析,而建立和维持一个良好的血液循环通路,是保证透析成功的首要条件。血液通路的建立,有体外动静脉瘘和体内动静脉瘘两种。因体外动静脉瘘的护理不便等各种原因,现基本不用。体内动静脉瘘随显微外科技术提高,已被广泛应用。1资料与方法我院自1999～2002年,应用显微外科技术进行动静脉内瘘手术92例,其中男性48例,女性44例,年龄31岁～65岁。手术方式:前臂头静脉与桡动脉端侧吻合88例,采用大隐静脉移植行贵要静脉与桡动脉端侧吻合4例。瘘口4mm～6mm,术后血流量300～500ml/min。内瘘使用时间1个月～3年,其中1例…     

血液透析患者动静脉内瘘护理体会

目的:研究血液透析患者动静脉内瘘的护理要点及要求,以提高患者动静脉内瘘护理的质量.方法:对我院40例动静脉内瘘血液透析患者的护理进行回顾性分析.结论:动静脉内瘘是维持性血液透析患者的生命线,只有加强对内瘘的护理,才能提高血透治疗.提高患者的生存质量.     

自体动静脉内瘘限流术在高流量内瘘中的应用

目的 回顾性分析近2年单中心高流量自体动静脉内瘘行限流术的原因及限流术的疗效,探讨高流量自体动静脉内瘘有效治疗方法.方法 收集2018年8月至2020年9月在海南省人民医院血液净化中心因高流量自体动静脉内瘘行限流术的23例患者的临床人口学信息、原发病、透析龄、限流术前、术后动静脉内瘘血流量.采用配对t检验分析术前、术后...     

彩色多普勒超声在血透动静脉内瘘功能评估中的应用

目的：探讨总结彩色多普勒超声在自体血管动静脉内瘘功能评估中的临床应用价值。方法：运用彩色多普勒超声技术检测自体血管动静脉内瘘功能。结果：716例自体血管动静脉内瘘中514例内瘘功能正常,202例出现不同类型并发症。结论：彩色多普勒超声技术检测自体血管动静脉内瘘功能评估中有很好的临床应用价值。     

维持性血液透析患者自体动静脉内瘘维护的研究进展

对目前国内外自体动静脉内瘘(AVF)的维护现状进行综述,提出在做好AVF穿刺综合护理的同时,定期监测内瘘血流量,重视AVF感染的预防护理,落实透析后的压迫止血护理,指导患者做好居家自我护理,并实施持续质量改进,以期减少AVF并发症,延长AVF使用寿命,提高透析患者的长期生存质量。     

血液透析患者动静脉瘘血流量对心功能的影响

目的 :探讨动静脉内瘘血流量对血液透析病人心功能的影响。方法 :动静脉内瘘 (AVF)术前后心脏彩色多普勒超声检查 ,观察心输出量 (CO)、心脏指数 (CI)、射血分数 (EF)、短轴缩短 (SF) ,同时测定吻合口直径 (AVFD)、动静脉内瘘血流量 (AVFB)值 ,且按术后彩色多普勒超声所测得的AVFD将病人分为A组AVFD >4mm ,B组AVFD≤4mm ,测定不同AVFD对血液透析病人血流动力学的影响。结果 :AVF术后病人CO、CI值比术前明显增高 (P <0 .0 1) ,EF、SF术前、术后变化不明显。AVFB、AVFD与CO差值 (△CO)、CI差值 (△CI)呈直线正相关 ,r =0 .4 99,P <0 .0 1。A组AVFB、△CO、△CI明显大与B组 ,具有统计学差异 (P <0 .0 0 1)。结论 :AVF术后对血液透析病人血流动力学的影响与AVFB、AVFD密切相关 ,如果瘘过大和 /或发生了高输出量性心衰则应采取措施以减少瘘血流量。     

Radiocephalic Wrist Arteriovenous Fistula for Hemodialysis: Meta-analysis Indicates a High Primary Failure Rate

OBJECTIVE: To improve the precision of the estimates of primary failure rates and primary and secondary 1 year patency of radial-cephalic arteriovenous fistulas (RCAVF) for hemodialysis. DESIGN: Meta-analysis. MATERIALS AND METHODS: A Medline search was performed of the English language medical literature between January 1970 and October 2002. Key words that were searched included radiocephalic fistula, arteriovenous shunt, Brescia-Cimino fistula and patency. Primary failure, primary and secondary patency rates were analysed using the standard mixed effects model, which allows for variability between the different studies. RESULTS: Eight prospective and 30 retrospective studies were included. The analysis showed a pooled estimated primary failure rate of 15.3% (95% CI: 12.7-18.3%). In addition, the pooled estimated primary and secondary patency rates of 62.5% (95% CI: 54.0-70.3%) and 66.0% (95% CI: 58.2-73.0%), respectively, were calculated. Subgroup analysis concerning various study characteristics, including study year, gender and age, did not reveal statistically significant differences. CONCLUSION: Although, the autogenous RCAVF is considered to be the primary choice for vascular access, this meta-analysis indicates a high primary failure rate and only moderate patency rates at 1 year of follow-up.     

Primary Arteriovenous Fistulas in the Forearm for Hemodialysis: Effect of Miscellaneous Factors in Fistula Patency

Background. The provision and maintenance of vascular access remains a major cost to end-stage renal failure programs. In addition, vascular access occlusion, results in significant morbidity in hemodialysis patients. Age, gender, diabetes mellitus, malignancy, smoking habits, administration of heparin per hemodialysis session, previous dialysis catheter insertion, number of hemodialysis sessions and location of the fistula may be associated with survival of the primary arteriovenous fistula. We examined the effects of various factors on fistulas in 412 chronic renal insufficiency patients. Methods. From 1995 to 2004, 412 arteriovenous fistulas were created by the Department of Cardiovascular Surgery at the Medical Faculty of Atatürk University for hemodialysis. The mean age of the patients was 45 years (range 6 to 62 years). We evaluated the effects of various factors for patency rates in the patients who had primary arteriovenous fistulas. Primary patency was defined as the duration of fistula patency without revision. Twenty-eight patients (6.7%) with ischemic cardiac disease did not require surgical interference. Analyzed data were age, gender, smoking habits, diabetes mellitus, malignant neoplasm, previous dialysis catheter insertion, number of hemodialysis sessions, and fistula location. Results. In 298 patients, where lower-arm radiocephalic fistulas were created, the fistula patency was 74.1%, 64.2%, 49.8%, 33.7%, and 4.1% after 1, 2, 3, 4, and 5 years, respectively, in the other 114 patients, where upper-arm fistulas were created, these rates were 84.0%, 72.2%, 53.3%, 39.8%, and 12.3%, respectively. There was no significantly difference between the upper-arm fistulas and the lower-arm fistulas statistically (p = 0.069). Factors affecting the primary patency of arteriovenous fistulas were diabetes mellitus (p = 0.0001), hemodialysis counts ≥3 per week (p < 0.0005), presence of malignancy (p < 0.0005), previous catheter insertion (p < 0.0007), and administration of heparin per hemodialysis session (p = 0.0008). Conclusion. While primary arteriovenous fistula patency was shortened in chronic renal insufficiency patients with diabetes mellitus, presence of malignancy, and previous catheter insertion, patency was longer in patients with heparin used for hemodialysis and hemodialysis count per week (≥3).     

Nuances of Arteriovenous Fistula Creation for Vascular Access in Hemodialysis

Background With rising incidence and increased life expectancy of patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD), the number of patients requiring hemodialysis has increased substantially. Vascular access is the lifeline for a patient on hemodialysis (HD), and an arteriovenous fistula (AVF) is the undisputed gold standard for HD access. An effective and long-lasting fistula serves to increase the life expectancy of ESRD patients and improves their quality of life. Learning Objectives This paper aims to give a comprehensive overview of AVF creation, including the various techniques, patient selection, troubleshooting with decision-making, and common complications. Authors share their experience from previous publications and over 2000 AVF surgeries. They have not only described a new modification of the technique of proximal fistula but have also established a direct correlation between bruit and thrill on operation table and success of fistula surgery. Conclusion A standardized, protocol-driven multidisciplinary approach with careful patient and site selection, guided by outcome predictors, is vital in AVF surgery. Knowledge about the potential complications of AVFs contributes to their timely detection and allows measures to be taken that might prevent deleterious consequences that range from loss of vascular access to serious morbidity and mortality.     

覆膜支架在自体动静脉内瘘狭窄治疗中的应用研究

目的:评价覆膜支架治疗自体动静脉内瘘(AVF)狭窄的临床疗效。方法:回顾性分析深圳大学第三附属医院2018年1月—2020年10月收治的45例AVF狭窄患者的临床资料,根据手术方式分为两组:覆膜支架组(17例)和球囊扩张组(28例),比较两组患者的临床效果。结果:覆膜支架组的6个月及12个月初级通畅率明显高于球囊扩张组(100.00% vs 78.57%, P=0.040; 100.00% vs 64.29%, P=0.005),差异有统计学意义。两组的6个月及12个月次级通畅率差异无统计学意义,两组术后并发症的发生率差异无统计学意义。结论:覆膜支架治疗AVF狭窄与单纯球囊扩张相比,可以明显提高6个月及12个月的初级通畅率,对于反复狭窄的AVF,植入覆膜支架后可明显延长患者的再次干预时间。     

血液透析患者前臂动静脉内瘘的临床应用研究

目的:探讨前臂自体动静脉内瘘在血液透析中的临床应用.方法:对采用前臂腕部自体动静脉内瘘术建立血管通路的112例慢性肾衰竭血液透析患者,进行回顾性分析探讨,建立前臂内瘘的血管条件、手术方式、近远期通畅率、并发症及临床处理原则等.结果:112例患者中,111例手术成功建立血管内瘘,手术一次成功率99.1%(111/112).4周内内瘘栓堵者5例,内瘘初级通畅率94.6%(106/112).其中1例通过药物溶栓获得再通,4例通过原切口行内瘘重建获得再通,累计次级通畅率为99.1%(111/112).动静脉吻合口狭窄致血栓形成是内瘘闭塞最常见因素,感染居其次.内瘘使用后0.5年和1年通畅率分别为97.3%(109/112)和95.5%(107/112).结论:前臂腕部自体动静脉内瘘术制作简便,远期通畅率高,且最大限度地保留了上肢的血管储备,是血液透析血管通路的首选.良好的血管条件和熟练的血管吻合技术是保证内瘘成功和长期通畅的关键因素.     

Transposed Basilic Vein-Brachial Arteriovenous Fistula: An Alternative Vascular Access for Hemodialysis

Twenty-five brachial-basilic arteriovenous (AV) fistulas with transposed basilic vein for alternative vascular access were created in 22 chronic hemodialysis patients. This surgical procedure was performed under brachial block or general anesthesia. After a longitudinal skin incision that was made in the inner side of the arm, the basilic vein was exposed, transposed subcutaneously, and anastomosed end-to-side to the brachial artery. The follow-up was between 7 and 24 months. Early complications were hemorrhage, thrombosis, steal syndrome, and swelling of the arm. Among the late complications were failure of the fistula because of thrombosis and multiple stenosis at the site of venipuncture. The accumulated one-year patency rate of fistulas was 81%. The complications of high-output cardiac failure or local infection were not seen in our study. On the basis of our results, the brachial-basilic AV fistula with transposed basilic vein is a useful and safe second- or third-choice vascular procedure for hemodialysis patients, in particular for women without good quality of vessels.     

50例球囊扩张下动静脉内瘘术的临床效果评价

目的：探讨球囊扩张下血液净化用前臂动静脉内瘘术的手术方法以及临床效果。方法：总结暨南大学附属第一医院肾内科2005年7月～2012年1月收治的50例诊断明确的尿毒症患者因需要长期透析以及血管条件差而行球囊辅助下前臂动静脉内瘘术。手术选择病人的非主力手,分别游离头静脉和桡动脉,结扎头静脉的远端向头静脉和桡动脉的近端分别插入动脉取栓导管并用2ml注射器向导管内注入适量肝素生理盐水,充起球囊,根据需要持续均匀的扩张头静脉和桡动脉的狭窄段,再以7-0的血管逢线端侧吻合血管。结果：术后即时、1、2、3h、术后连续7d均能听到血管杂音以及扪及到血管震颤平均随访60个月手术的成功率90%以上。已有30例病人内瘘成熟并已使用超过3年以上,内瘘的血流量均大于250ml/min,完全能满足各种血液净化治疗的需要。结论：球囊辅助下前臂动静脉内瘘术手术成功率高,可以纠正动静脉血管条件差伴有部分狭窄的患者,内瘘成熟快,血流量大,临床效果好。     

维持性血液透析患者自体动静脉内瘘失功的影响因素分析

目的：回顾性分析维持性血液透析患者自体动静脉内瘘（AVF）失功的影响因素。方法：以我院血透中心73例首次发生自体AVF失功的患者为内瘘失功组,选取同期自体AVF功能良好的136例维持性血液透析患者为内瘘通畅组,比较两组患者各项临床及生化指标,分别进行单因素分析及logistic回归分析。结果：内瘘失功组和通畅组在年龄、糖尿病、血红蛋白、血清白蛋白、血小板、三酰甘油、血清铁、C反应蛋白（CRP）、血钾、血磷、甲状旁腺激素（PTH）等方面差异存在统计学意义（P〈0.05）;logistic回归分析显示患有糖尿病（OR=1.551）,血清白蛋白（OR=1.061）、三酰甘油（OR=1.275）、血磷（OR=1.580）水平是内瘘失功的危险因素;内瘘失功组的生存分析显示糖尿病患者内瘘的中位生存时间为7个月,非糖尿病患者为27个月,差异有统计学意义（P=0.002）;分别进行内瘘失功组和通畅组的组内比较,糖尿病患者与非糖尿病患者在血清白蛋白、三酰甘油、血磷方面差异存在统计学意义（P〈0.05）。结论：糖尿病、血清白蛋白、三酰甘油、血磷水平是内瘘失功的危险因素,糖尿病患者内瘘使用时间明显短于非糖尿病患者,其影响因素与血清白蛋白、三酰甘油、血磷水平密切相关。