296例维持性血液透析患者动静脉内瘘建立的临床分析 |
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引用本文: | 冯亚平,张福先,张昌明,胡路,邢晓燕,梁刚柱,牛鹿原.296例维持性血液透析患者动静脉内瘘建立的临床分析[J].医学临床研究,2010,27(5):789-791. |
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作者姓名: | 冯亚平 张福先 张昌明 胡路 邢晓燕 梁刚柱 牛鹿原 |
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作者单位: | 北京世纪坛医院血管淋巴外科中心,北京,100038 |
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摘 要: | 目的]探讨建立血液透析(HD)通路的时机及提高手术成功率和远期通畅率的影响因素.方法]回顾性分析296例尿毒症患者(321次)动静脉内瘘建立的情况.结果]上肢自体动静脉内瘘(AVF)一期成功率96.51%,而肘部、下肢自体AVF及人工血管AVF术为100%.人工血管AVF较自体AVF成熟时间短(P〈0.05).鼻烟窝及人工血管内瘘较易发生血栓形成(P〈0.05);而端-侧吻合较少(P〈0.05);肘窝、下肢自体AVF及人工血管AVF内瘘易成熟(P〈0.05).结论]腕部头静脉-桡动脉端-侧吻合(标准内瘘)是首选;改良侧-侧吻合对血管条件好的患者亦有较高成功率;人工血管内瘘为自体内瘘失败者提供了更多的选择.
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关 键 词: | 动静脉瘘 血液透析 |
Clinical Analysis of Internal Arteriovenous Fistula Establishment of 296 Maintenance Hemodialysis Patients |
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Institution: | FENG Ya-ping, ZHANG Fu-xian, ZHANG Chang-ming,et al ( Blood Vessel and Lymph Surgery Center, Shijitan Hospital, Beijing 100038, China ) |
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Abstract: | Objective] To explore the time of the establishment of hemodialysis access, and the factors for improving success rate of surgery and long-term patency rate. Methods]A total of 296 uremia patients who established hemodialysis access were analyzed retrospectively. Results] The one-stage successful rate of au- tologous arteriovenous fistula(AVF) in upper extremity was 96.51%, and the successful rate of AVF in cubital fossa and lower extremity and artificial blood vessel arteriovenous fistula was 100%. The maturation time of artificial vessel AVF was shorter than that of autologous AVF( P 〈0.05). Compared to other parts of fistula thrombosis, snuffbox fistula and artificial blood vessels had high incidence( P〈0.05). But the incidence of thrombosis of end-side anastomosis was lower( P 〈0.05). In the maturation, all the cubital fossa AVF, lower extremity autologous AVF and artificial vessel AVF had obvious advantages( P 〈0.05). Conclusion] The end-side anastomosis of wrist cephalic vein and radial artery (standard fistula) is first choice. Modified side-side anastomosis for patients with good vascular conditions has relatively high successful rate. Artificial vessel AVF provides more good options for patients whose autologous fistulas are failure. |
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Keywords: | arteriovenous fistula hemodialysis |
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