动静脉内瘘吻合术后运用疏血通抗凝的临床观察

血管通路是尿毒症患者接受血透的先决条件，自体动静脉内瘘因其方便、安全、使用寿命长、并发症少、很少需要干预治疗等优点而成为最主要的血管通路，而血栓形成是导致动静脉内瘘无法使用的最常见原因。疏血通注射液有活血化瘀、通经活络之功效，能改善尿毒症患者血液高凝高黏状态，抑制血栓的形成并能使已形成的血栓溶解。我们近2年来常规在动静脉内瘘成形术后使用疏血通预防阻塞，通过与前3年随机挑选病例的比较，证实疏血通注射液具有保护动静脉内瘘作用。     

三七灸促进动静脉内瘘成熟疗效观察

血管通路是终末期肾脏病（ESRD）患者的生命线,而透析通路失去功能（失功）是维持性血透患者高住院率、高死亡率的重要原因.目前应用最广泛的血管通路为自体动静脉内瘘（native arteriovenous fistula,AVF）,其长期通畅率、感染率、花费方面均明显优于移植血管内瘘或者半永久深静脉置管,但是要维持长期血管通路通畅较为困难,AVF术后常因血栓、感染等并发症导致内瘘失功.故在内瘘术后,除了加强对患者的自我保护知识的宣教外,早期的中医治疗干预也成为一种较理想的措施.我中心采用隔三七灸动静脉内瘘,对于促进动静脉内瘘成熟取得了较为理想的效果,现报道如下.     

疏血通注射液在动-静脉内瘘成形术后的应用

目的 探讨疏血通注射液在糖尿病血液透析患者动-静脉内瘘成形术术后的治疗作用.方法 选择原发病因为糖尿病的慢性肾功能衰竭患者24例.其中治疗组12例,在动-静内瘘成形术后给予疏血通注射液4ml+生理盐水250ml静脉滴注,每天1次,疗程半个月.对照组12例患者术后常规给予双嘧达莫(商品名:潘生丁)25 mg,每天3次口服.观察两组患者治疗前、后血脂、血液流变学和凝血常规情况,统计内瘘成熟时间以及透析时所能达到的血流量.结果 治疗组患者用疏血通注射液治疗后内瘘无一例闭塞.成熟时间短、透析时平均血流量可达240 ml/min、血浆黏滞度和纤维蛋白原降低、凝血酶原时间及活化部分凝血酶原时间延长,与治疗前比较差异有统计学意义(P＜0.05);治疗后各项指标与对照组比较差异也有统计学意义(P＜0.05).对照组内瘘闭合1例,成熟时间长,平均血流量为210 ml/min,治疗前、后血浆黏滞度、纤维蛋白原及凝血酶原时间比较差异无统计学意义(P＞0.05).结论 疏血通注射液能降低血液黏滞度、促进动-静脉动内瘘成熟,增加血流量,有效地减少内瘘的闭合.     

局部尿激酶溶栓治疗血透患者自体动静脉内瘘血栓形成的疗效及随访观察

自体动静脉内瘘（autogenousarterio—VENOUSfistu—las,AVF）是血液透析患者血管通路的第一选择。动静脉内瘘血栓形成是血液透析患者内瘘失功的主要原因。目前虽然有经导管溶栓术、带气囊导管取栓术、经皮血管成形术及内支架置入术等一系列创伤小见效快的方法治疗动静脉内瘘血栓形成,但费用较高,操作较为复杂[1]。应用尿激酶局部注射治疗动静脉内瘘血栓形成,花费少,操作简单,但各家文献报道的治疗方案及疗效不一,且较少有后续治疗方案及预后报道。本文分析了姜堰市人民医院血液净化中心2005年1月～2012年4月收治的26例30例次局部注射尿激酶治疗动静脉内瘘血栓形成伴后续巩固治疗的临床资料,研讨局部注射尿激酶治疗动静脉内瘘血栓形成的治疗方案及溶栓成功后的后续治疗疗效,随访其长期通畅率。     

喜疗妥软膏联合红外线照射对血液透析患者自体动静脉内瘘影响的Meta分析

正进行性和永久性肾衰竭常用血液透析来治疗~([1])。血液透析治疗的效率依赖于血管通路的功能状态,临床上最理想且应用最广泛的透析血管通路仍为自体动静脉内瘘,自体动静脉瘘(AVF)的正常功能是至关重要的~([2])。血管通路(VA)指南建议将自体动静脉瘘(AVF)作为血液透析患者的首选,AVF管理在血液透析患者护理中非常重要~([3,4])。自体动静脉内瘘一般6～8周形成,内瘘成熟质量直接影响其首次使用时间及使用寿     

红花酒湿敷保护维持血液透析患者动静脉内瘘的效果评价

良好的血管通路是血液透析治疗的基本保证,是患者赖以生存的生命线。目前在各种血管通路中,自体动静脉内瘘（arteriovenous fistula,AVF）具有最佳的长期技术成活率。根据美国＂肾脏病预后质量倡议＂指南推荐,AVF是首选的血管通路选择。     

180例血液透析患者自体动静脉内瘘闭塞临床分析

动静脉内瘘（AVF）是血液透析患者的生命线，其血流充足、安全、使用方便，已常规作为维持性血液透析的血管通路。AVF的好坏直接影响血透患者的生活质量及长期存活，因此维护血管通路的通畅保证足够的血流量尤为重要。为保证血液透析有充足的血流量（250～300ml／min）且能够长期使用的血流通路，临床上一般将血液透析患者桡动脉和邻近静脉做血管吻合，建立自体动静脉内瘘，但是要维持长期血管通路通畅较为困难。由于终末期肾病患者常合并严重贫血、电解质紊乱、营养不良、心功能不全、血压不稳定等，极易造成动静脉内瘘的闭塞。我们分析了我院部分血液透析患者发生动静脉内瘘闭塞的危险因素及处理，以飧读者。     

血液透析患者动静脉内瘘的处置经验

血液透析是终末期肾病患者进行肾脏替代治疗应用最多的方式.建立和维护理想的血管通路是保证透析顺利完成的重要条件之一.而动静脉内瘘（arteriovenous fistula,AVF）是血液透析患者主要的长期血管通路,其功能状况将直接影响血液透析患者的透析状况[1].因此,AVF是血液透析患者的“生命线”.如何保护AVF,提高其使用年限,减少内瘘并发症,从而提高患者的透析质量,是血液净化中心护理工作的重点.优质护理是以患者为中心,以促进患者康复为目的的护理.由于AVF关系透析患者生命,因此,对动静脉内瘘患者实行优质护理可以提高患者的生存质量[2].     

自体动静脉内瘘成熟影响因素及机制研究进展

血管通路是终末期肾脏病(end stage renal disease,ESRD)患者维持血液透析的生命线,自体动静脉内瘘(arteriovenous fistula,AVF)因其使用时间长、并发症少等特性,是目前临床首选的血管通路.AVF建立以后需要经过4周以上的血管重塑过程才能达到成熟,提供满足血液透析治疗所需的穿...     

人工血管动静脉内瘘术后肢体肿胀的原因及防治

<正>血液透析是慢性肾功能不全终末期患者赖以生存的肾脏替代治疗方法之一。良好的血管通路是保障透析治疗能够正常进行的必要条件,是患者的生命线。自体动静脉内瘘(arteriovenous fistula,AVF)是透析通路的首选,但部分患者由于自身血管条件差,尤其近些年来,随着患者透析时间延长,人口老龄化,并发多种内科疾病,如糖尿病、高血压等,失去建立AVF条件的患者逐年增加,人工血管动静脉内瘘(arteriovenous graft,AVG)成为这部分患者维持性血液透析通路的首选[1-2]。术侧肢体肿胀是人工血管动静脉内瘘术后一种常见的并发症,资料显示,上肢袢式(U形)AVG术后肿胀发生率可     

香丹注射液治疗冠心病疗效分析

目的观察香丹注射液治疗冠心病的临床疗效。方法 118例冠心病住院患者随机分为治疗组与对照组,对照组49例采用常规治疗,香丹组69例在常规治疗基础上静脉滴注香丹注射液,用药前后分别观察其主要症状、心电图的改变,并测定两组患者血液流变学及血脂指标。结果香丹组治疗后多项指标较治疗前显著改善（P〈0.05或0.01）,较对照组也有显著改善（P〈0.05或0.01）。结论香丹注射液不仅可以显著改善冠心病患者临床症状,同时可降低高黏血症患者的血液黏稠度及血脂水平。     

疏血通对髋部术后患者血浆内皮素水平的影响

目的：探讨疏血通注射液对髋部术后患者血浆内皮素水平变化的影响及其临床意义。方法：将50例髋部术后患者随机分为两组,均行常规基础治疗,疏血通组23例,给予疏血通注射液静脉滴注;低分子肝素钠组27例患者,给予低分子肝素钠皮下注射,疗程均为14d。结果：两组血浆内皮素水平均较术后第3d明显下降（P〈0.05）,且疏血通组的含量明显低于低分子肝素钠组,P〈0.05。结论：疏血通注射液可使髋部术后血浆内皮素含量降低,调节凝血和抗凝功能的动态平衡,降低下肢深静脉血栓的发生率。     

疏血通联合低分子肝素钠治疗深静脉血栓的疗效观察

目的探讨疏血通联合低分子肝素钠治疗下肢深静脉血栓症的临床疗效和安全性。方法将70例下肢深静脉血栓症患者随机分为试验组和对照组,每组各35例。对照组予低分子肝素纳5000U皮下注射,每12小时1次。试验组在此基础上加用疏血通注射液6mL＋生理盐水250mL静脉点滴,每天1次,10d为一疗程。结果试验组总有效率94.3%,对照组为68.6%,两组比较差异有统计学意义（P〈0.05）,两组均未出现严重不良反应。结论疏血通联合低分子肝素钠治疗下肢静脉血栓症疗效显著,安全性好。     

前列地尔注射液联合香丹注射液治疗缺血性结肠炎的临床研究

为观察前列地尔注射液联合香丹注射液治疗缺血性结肠炎的疗效,将34例缺血性结肠炎患者随机分为两组,每组17例。所有病例均给予单纯抗生素和其他常规支持对症治疗;治疗组在此基础上加用前列地尔注射液和香丹注射液。观察记录腹痛缓解、大便潜血阴性及肠黏膜愈合时间等指标。结果显示,治疗组在腹痛缓解、大便潜血恢复及肠黏膜愈合时间方面明显优于对照组（P〈0．05）。结果表明,前列地尔注射液联合香丹注射液治疗缺血性结肠炎疗效显著。     

线上线下延续护理对自体动静脉内瘘成熟期患者的影响

目的 探讨线上线下联合的延续护理对自体动静脉内瘘成熟期患者自我管理能力的影响。 方法将243例行自体动静脉内瘘术患者按照住院时间分为对照组121例和观察组122例。对照组实施常规延续护理,观察组实施线上线下联合的延续护理,包括住院期间线下健康教育和出院后线上利用移动宣教平台进行居家护理指导。比较两组自体动静脉内瘘成熟情况、自体动静脉内瘘护理能力及延续护理满意度。结果干预后,观察组自体动静脉内瘘成熟情况、内瘘护理能力各条目评分及患者对延续护理满意度显著高于对照组（均P＜0.05）。结论线上线下联合的延续护理能够促进自体动静脉内瘘的成熟,改善患者内瘘自我管理能力,提高患者对护理工作的满意度。     

Pre-operative radial arterial diameter predicts early failure of arteriovenous fistula (AVF) for haemodialysis.

INTRODUCTION: Long term patency of arteriovenous fistula (AVF) is relevant to the management of end stage renal failure (ESRF) patients on haemodialysis (HD). We evaluated the role of routine radial arterial duplex for imaging radial artery before AVF formation to investigate the relationaship between radial artery internal diameter (ID) and AVF patency. METHODS: 21 patients with ESRF were examined by duplex sonography before AVF formation, 1 day, 1 week, 4 week and 12 weeks post AVF formation. For assessment of AVF patency, patients were divided into 2 groups. Group-1, 11 patients with radial artery ID <1.5mm and Group-2, 10 patients with radial artery ID >1.5mm. Measurement of radial artery blood inflow rate was calculated from mean blood flow velocity and vessel diameter. All AVFs were constructed on the forearm using autologous veins. RESULTS: In Group-1, 5 patients (45%) showed immediate thrombosis of AVF graft. All patients in group-2 had patent AVF at 12 weeks. Pre-AVF formation radial artery blood inflow rate between two groups was not significantly different (p=0.06). Radial artery blood inflow rate was consistently and significantly higher in group-2 at all later time points with p value of <0.01 (Mann Whitney test). CONCLUSION: There was a high failure rate of AVF with radial artery ID of <1.5mm. In the presence of small radial arteries primary access AVF in the upper arm should be considered.     

Arteriovenous fistula outcomes in the era of the elderly dialysis population

BACKGROUND: The growth of patients > or =65 years on hemodialysis is increasing. Guidelines recommend arteriovenous fistula (AVF) access but their outcomes in elderly patients are controversial. This study compared the outcomes of AVF in patients <65 years old (65- group) versus those > or =65 years old (65+ group). METHODS: This retrospective analysis of prospectively collected data included 444 incident, first-time AVF created in a large dialysis center between January 1, 1995 and July 1, 2003. The primary outcome of AVF cumulative patency was evaluated using Kaplan-Meier survival analysis with log-rank test comparison. A Cox model determined factors associated with AVF loss. RESULTS: One hundred ninety-six patients (44%) were in the 65+ group. In total, there were 230 (52.2%) radiocephalic, 186 (42.2%) brachiocephalic, and 25 (5.6%) basilic vein transposed AVF. The one-year AVF cumulative survival was 75.1% (65+ group) and 79.7% (65- group); the five-year survival was 64.7% (65+ group) and 71.4% (65- group). The overall total procedure, angioplasty, thrombolysis, and revision rates per access-year were 0.83, 0.30, 0.66, and 0.16, respectively. The 65+ group had a relative risk of 1.7 of their AVF failing to mature compared with the 65- group. Multivariate analysis yielded these variables significant for AVF loss: male sex HR 0.63 (95% CI 0.44-0.91), coronary artery disease HR 2.1 (95% CI 1.5-3.0), and Caucasian ethnicity HR 0.63 (95% CI 0.44-0.91). CONCLUSION: Age should not be a limiting factor when determining candidacy for AVF creation due to equivalent survival and procedural rates. Failure of fistula maturation is a primary concern to patients of all ages and demands further study.     

Vascular access for hemodialysis: the impact on morbidity and mortality

BACKGROUND: In chronic hemodialysis (HD), central venous catheter (CVC) use seems associated with an increased risk of death. This study, using registry data, evaluated the morbidity and mortality risk associated with the use of different permanent vascular access (VA) in a HD patient cohort. METHOD: We evaluated hospitalization and death rate in prevalent and incident HD patients recorded in the uremic registry of Campania (southern Italy) for 2001. Patients were divided into three groups: CVC, artero-venous graft (AVG) and artero-venous fistula (AVF). RESULTS: One hundred and eleven dialysis units in the Campania region (69%) provided data. A total of 2201 out of 3387 prevalent HD patients were included: 92 patients (4.2%) were on CVC, 24 patients (1.1%) were on AVG and 2085 patients (94.7%) were on AVF. In comparison with AVF, the CVC group had a greater prevalence of female gender, old age, diabetes, comorbidities, hypoalbuminemia, anemia, erythropoietin (EPO) resistance, and less frequent synthetic membrane use, but had a similar dialysis duration (hr/week). Similar data were collected in the 635 incident patients registered in 2001. During the study, in both prevalent and incident CVC patients, either hospitalization or death rates were enhanced; however, the difference in the relative risk (RR) of death disappeared after correction for age, gender, malnutrition, diabetes, hemoglobin, albumin and comorbidity. Among incident patients, survival analysis was performed in patients remaining on the same VA type throughout the follow-up period; while a similar survival between groups was demonstrated in the 1st year of follow-up, survival was worse in the CVC group during the 2nd year of follow-up; however, this difference also disappeared in the adjusted analysis. CONCLUSION: This cohort study demonstrates that in chronic dialysis patients CVC choice, with respect to AVF, is mainly associated with female gender, advanced age and worse clinical conditions at baseline, and a worst outcome in both prevalent and incident CVC patients compared to AVF patients. Hospitalization, mortality rate and RR of death increased significantly; however, differences disappeared after correction for comorbidity. Therefore, these data suggest that CVC use per se is not associated with increased mortality risks with respect to AVF.     

Effect of radial artery calcification on survival of arteriovenous fistula and the patients in end-stage renal disease patients

Objective To investigate the effect of radial artery calcification (RAC) on survival of arteriovenous fistula (AVF) and the patients in end-stage renal disease. Methods Adult ESRD patients undergoing AVF surgery between January 2013 and January 2016 at the Eighth Affiliated Hospital of Sun Yat-sen University were enrolled in this study. The clinical and biochemical data were collected. Segment of radial artery were obtained from the operation of AVF. RAC at the site of anastomotic were observed by alizarin red S and hematoxylin and eosin staining. According to RAC, the patients were divided into calcification group and non-calcification group. Kaplan-Meier analysis was performed to analyze the survival rates of the two groups, and Cox proportional hazards regression model was used to estimate the risk factors of AVF dysfunction and all-cause mortality in ESRD patients. Results Among 180 cases of ESRD patients, 38 cases (21.1%) were developed RAC at the site of anastomotic in different degrees. Compared with the non-calcification groups, the calcification groups had a longer dialysis vintage, a higher proportion of diabetes and higher level of HbAlc (all P﹤0.05). Binary logistic regression analysis showed that dialysis vintage＞5 years and diabetics were two independent risk factors of RAC at the site of anastomotic. Kaplan-Meier survival analysis demonstrated that there were no statistical differences between two groups in AVF survival ( χ2=0.009, P=0.926). Calcification group had higher all-cause mortality than non-calcification groups ( χ2=9.809, P=0.002). Multivariate Cox regression analysis demonstrated that homocysteine was independent risk factor for AVF dysfunction (HR=1.027, 95%CI: 1.003-1.051, P=0.027). Age was independent risk factor for all-cause mortality (HR=1.078, 95%CI: 1.035-1.122, P=0.000). Conclusions Dialysis vintage＞5 years and diabetes were two independent risk factors of RAC at the site of anastomotic in ESRD patients. RAC at the site of anastomotic had no effect on AVF survival, but increased all-cause mortality.