即穿型人工血管内瘘与膨体聚四氟乙烯人工血管内瘘建立血液透析通路的疗效比较  

Treatment efficacy of immediate-access grafts compared to expanded polytetrafluoroethylen grafts in hemodialysis access

作　　者：缪鹏[1,2] 谭正力 田然[1] 姚辰亮[1] 曹放 郁正亚 陈忠[2] MIU Peng;TAN Zheng-li;TIAN Ran;YAO Chen-liang;CAO Fang;YU Zheng-ya;CHEN Zhong(Department of Vascular Surgery,Beijing Tongren Hospital of Capital Medical University,Beijing 100730,China;Department of Vascular Surgery,Beijing Anzhen Hospital of Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京同仁医院血管外科,北京100730 [2]首都医科大学附属北京安贞医院血管外科,北京100029

出　　处：《中国血管外科杂志（电子版）》2019年第3期211-215,224,共6页Chinese Journal of Vascular Surgery(Electronic Version)

基　　金：首都医科大学附属北京同仁医院科研种子基金项目(TRYY-KYJJ-2016-035)

摘　　要：目的比较即穿型人工血管与膨体聚四氟乙烯(ePTFE)人工血管建立血液透析通路的治疗效果。方法回顾性分析2016年6月至2018年6月在首都医科大学附属北京同仁医院接受人工血管内瘘手术患者,包括即穿型人工血管23例,ePTFE人工血管144例,比较两组基本资料、临床数据、围术期及远期并发症、长期通畅率及中心静脉导管留置及拔除时间等结果。结果即穿型人工血管组23例随访18个月生存率为91.3%,ePTFE人工血管组生存率为94.5%。即穿型人工血管组及ePTFE人工血管组术后6、12、18个月初级通畅率分别为81.09%、57.52%、38.35%及73.05%、49.65%、26.24%,两组比较差异无统计学意义(P>0.05)。即穿型人工血管组及ePTFE人工血管组术后6、12、18个月次级通畅率分别为95.65%、67.16%、55.97%及87.15%、72.63%、51.4%,两组比较差异无统计学意义(P>0.05)。即穿型人工血管组术后初次穿刺时间(3.2±2.0)d,术后透析导管移除时间(3.8±1.6)d。ePTFE组术后人工血管初次穿刺时间(29.6±9.7)d,术后透析导管移除时间(53.8±29.3)d。即穿型人工血管组相较ePTFE人工血管组在人工血管初次穿刺时间、同期合并中心静脉导管手术及术后拔除透析导管时间差异均有统计学意义(P<0.05)。结论即穿型人工血管内瘘较ePTFE人工血管内瘘在通畅率及血栓形成、感染等并发症无显著差异,但其在早期人工血管穿刺透析、减少中心静脉导管留置时间及并发症均优于ePTFE人工血管。Objective To compare the clinical efficacy of immediate-access grafts and standard expanded polytetrafluoroethylen(ePTFE)grafts.Methods The clinical date of patients received operations of immediate-access grafts(23 cases)or standard ePTFE grafts(144 cases)during June 2016 to June 2018 from Beijing Tongren Hospital,Capital Medical University were enrolled retrospectively.The data of demographic,clinical outcomes,peri-operative and long-term complications,patency as well as the treatment of central venous catheter of two groups were analyzed.Results The survival rate in 18 months of immediate-access grafts group was 91.3%while was 94.5%in ePTFE grafts group.At 6,12 and 18 months of follow-up,primary patency rate of immediate-access group was 81.09%,57.52%,38.35%while ePTFE group was 73.05%,49.65%,26.24%,respectively.There was no significance differences(P>0.05).Secondary patency rate of immediate-access group was 95.65%,67.16%,55.97%while ePTFE group was 87.15%,72.63%,51.4%,respectively.There was no significance differences(P>0.05).The mean time of first puncture in immediate-access group was(3.2±2.0)days while(29.6±9.7)days in ePTFE group.The mean time of remove of central venous catheter in immediate-access group was(3.8±2.0)days while(53.8±29.3)days in ePTFE group.There were statistically differences in the time to first cannulation,time to tunneled catheter removal,catheter-related complications compared from immediate-access grafts to standard ePTFE grafts(P<0.05).Conclusion Immediate-access grafts have similar patency,thrombosis events and infection rates compared to ePTFE grafts.Immediate-access grafts allow earlier cannulation and tunneled catheter removal,thereby significantly decreasing catheter related complications.

关 键 词：即穿型人工血管 膨体聚四氟乙烯人工血管 血液透析 中心静脉导管 

分 类 号：R47[医药卫生—护理学]