不同部位动静脉内瘘对老年尿毒症患者血液透析疗效的影响  

Influence of arteriovenous fistula at different site on the effect of hemodialysis in elderly patients with uremia

作　　者：胡浩强[1] 周红梅[1] 刘国辉[1] 谢满静[1] 

机构地区：[1]广东省东莞市人民医院,523000

出　　处：《中国现代医药杂志》2014年第12期33-36,共4页Modern Medicine Journal of China

摘　　要：目的探讨3种不同部位动静脉内瘘对老年尿毒症患者血液透析疗效的影响。方法选取2011年7月~2013年6月我院收治的118例老年尿毒症患者,采用显微外科技术建立动静脉内瘘,根据建立部位的不同分为腕部内瘘组（43例）、上肢前臂内瘘组（37例）和上臂肱动脉内瘘组（38例）,比较各组不同时间的内瘘血流量、通畅率及并发症等。结果上臂肱动脉内瘘组的内瘘血流量最高,达（336.25±70.14）ml/min,明显高于腕部内瘘组和上肢前臂内瘘组,差异有统计学意义（P〈0.05）,而3组动静脉内瘘的成熟时间、开始应用时间比较无显著差异（P〉0.05）。在血流通畅方面,3组1个月通畅率无明显差异（P〉0.05）,但上臂肱动脉内瘘组1年、2年和3年的通畅率（分别为76.32%、60.53%和52.63%）均明显低于其余两组,差异有统计学意义（P〈0.05）。上臂肱动脉内瘘组3年内血栓形成、充血性心力衰竭、假性动脉瘤发生率分别为21.05%、31.58%和26.32%,较其余两组呈明显上升趋势,差异有统计学意义（P〈0.05）。结论老年尿毒症患者血管条件普遍较差,可根据自身情况选用内瘘位置,需密切注意后期通畅率和并发症情况,及时采取应对措施。Objective To discuss the influence of three kinds of arteriovenous fistula on the effect of hemodialysis in el- derly patients with uremia. Methods Overall 118 elderly patients with uremia in our hospital were selected to establish arte- riovenous fistula by microsurgical technique from Jul 2011 to Jun 2013. According to the arteriovenous fistula site,the patients were divided into three groups ,43 cases in wrist arteriovenous fistula group, 37 cases in forearm arteriovenous fistula group and 38 cases in brachial artery arteriovenous fistula group. The blood flow, flow rate and the complications of arteriovenous fistula among groups were compared. Results The blood flow in brachial artery arteriovenous fistula group was as high as （336.25± 70.14）ml/min, significantly higher than those of the other two groups （P〈0.05）,but the mature time and time to start dialysis of the three groups had no statistical difference （P〉0.05）. In terms of blood flowing, three groups of 1 month patency rate had no ob- vious difference （P〉0.05）, but the 1 year, 2 years and 3 years patency rate in brachiai artery arteriovenous fistula group were 76.32%, 60.53% and 52.63%, were significantly lower than those of the other two groups （P〈0.05）. The rate of thrombosis, con- gestive heart failure and pseudoaneurysms in brachial artery arteriovenous fistula group were 21.05% ,31.58% and 26.32%, it showed a rising trend compared with the other two groups （P〈0.05）. Conclusion The blood vessel condition of elderly patients with uremia are always bad, the fistula site should be selected according to their condition, but it need to be closely monitored and deal with the late patency rate and complications.

关 键 词：动静脉内瘘 尿毒症 老年 血液透析 

分 类 号：R459.5[医药卫生—治疗学]