自体动静脉内瘘在终末期肾病血液透析患者中的临床应用

目的分析自体动静脉内瘘在终末期肾病患者中的应用及其初期成熟影响因素。方法回顾分析135例行自体动静脉内瘘手术的终末期肾病患者的临床资料,探讨性别、年龄、原发病、术前血清白蛋白、血红蛋白、血肌酐、尿素氮及血压、术后抗凝治疗与内瘘初期成熟相关性以及1年内的并发症。结果126例内瘘成熟,9例患者失败;Logistic回归分析显示血压低于100/60 mm Hg患者血压与内瘘初期成熟呈负相关(P<0.01),术后应用抗凝治疗与内瘘初期成熟呈正相关(P<0.05);内瘘成熟后1年,通畅率98.4%(124/126例次),栓塞率为1.6%(2/126例次),无感染;每例内瘘平均透析次数为(132.2±8.6)次/年,平均透析时间为(530.4±28.2)h/年,透析血流量200~250 ml/min。结论自体动静脉内瘘为一种永久性血液透析通路,其并发症主要为栓塞;血压低于100/60 mm Hg的患者内瘘初期成熟率较低,术后应用抗凝治疗可减少内瘘栓塞的发生率。

Using native arteriovenous fistulas as the blood access in ESRD hemodialysis patients

Objective To analyse native arteriovenous fistulas as the blood access used in ESRD patients.Methods The age,sex,serum albumin,hemoglobin,serum creatinine,BUN,pre-operation blood pressure and post-operation anticoagulant drugs in 135 patients with ESRD who received native AVFs were analyzed.The relationship between these factors the success rate of AVFs was investigated;The AVFs using time and complications in one year were observed.Results AVFs were successful in 126 cases and failed in 9 patients.Multivariance analysis(logistic regression) showed blood pressure lower than 100/60 mm Hg has negative relation with AVFs operation success,anticoagulant therapy has positive relation with AVFs operation sucess.After one year,98.4%(124/126)AVFs were still using,embolism presented 1.6%(2/126).The average using time was 530.4±28.2 hour per year.The average dialysis times were 132.2±8.6 times per year.The blood flow was 200-250ml/min.Conclusion As permanent blood access,native AVFs have few complications with main complication of embolism.ESRD poctients whose blood pressure is lower than 100/60 mm Hg have higer oppotunity of native AVFs failure.Using auticoagulant drugs can decrease these failure.