维持性血液透析患者不同自体动静脉内瘘术式对透析效能、管路通畅率、炎性因子指标及并发症的影响  

The effects of different autogenous arteriovenous fistula surgical methods on dialysis efficiency,pipeline patency rate,inflammatory factors and complicationsin patients with maintenance hemodialysis

作　　者：王娅敏 温怡 刘智美 苟玉竹 WANG Ya-min;WEN Yi;LIU Zhi-mei;GOU Yu-zhu(West China Hospital,Sichuan University/West China School of Nursing,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院/四川大学华西护理学院,四川成都610041

出　　处：《实用医院临床杂志》2021年第3期87-89,共3页Practical Journal of Clinical Medicine

摘　　要：目的探讨维持性血液透析(MHD)患者采取不同自体动静脉内瘘术式(头静脉-桡动脉AVF和肱动脉-肘正中静脉AVF)的临床效果。方法我院收治的105例MHD患者,其中行头静脉-桡动脉AVF者57例(A组),行肱动脉-肘正中静脉AVF者48例(B组)。比较两组管路通畅率、并发症、透析效能差异性,观察治疗前后炎症因子指标[超敏C反应蛋白(hs-CRP)、β2微球蛋白(β2-MG)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]变化情况。结果A、B组12个月管路初级通畅率比较,差异无统计学意义(P>0.05);A组假性动脉瘤发生率、血管通路血流量、尿素氮清除指数、尿素氮下降率均低于B组(P<0.05);透析治疗6个月后,两组血清hs-CRP、IL-6、TNF-α、β2-MG水平均较治疗前降低(P<0.05),组间比较差异无统计学意义(P>0.05)。结论MHD患者采取头静脉-桡动脉AVF和肱动脉-肘正中静脉AVF均可得到较高的管路通畅率,对炎症因子的清除效果也较好,其中肱动脉-肘正中静脉AVF的透析效果更好,但并发症相对较多。Objective To explore the clinical effects of different autogenous arteriovenous fistula surgical methods(cephalic vein-radial artery AVF and brachial artery-median cubital vein AVF)in the treatment of patients with maintenance hemodialysis(MHD).Methods A retrospective analysis was performed on 105 patients with MHDadmitted to our hospital.The patients were divided intothe cephalic vein-radial artery AVF(group A,n=57)and brachial artery-median cubital vein AVF(group B,n=48).The pipeline patency rate,complications and dialysis efficiency were compared between the two groups,and the inflammatory factors such as high-sensitivity C-reactive protein(hs-CRP),β2 microglobulin(β2-MG),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)were observed before and after treatment.Results There was no significant difference in the 12-month primary pipeline patency rates between the two groups(P>0.05).The incidence rate of pseudoaneurysm,vascular access blood flow,urea nitrogen clearance index and decrease rate of urea nitrogen in the group A were lower than those in the group B(P<0.05).After 6 months of dialysis treatment,the levels of serum hs-CRP,IL-6,TNF-αandβ2-MG in the two groups were lower than those before treatment(P<0.05),and there were no significant differences between the two groups(P>0.05).Conclusion Both cephalic vein-radial artery AVF and brachial artery-median cubital vein AVF for patients with MHD can achieve higher pipeline patency rate and have a better effect on eliminating inflammatory factors.Brachial artery-median cubital vein AVF has better dialysisefficiency but has relatively more complications.

关 键 词：维持性血液透析 自体动静脉内瘘 头静脉-桡动脉内瘘 肱动脉-肘正中静脉内瘘 管路通畅 并发症 

分 类 号：R459.5[医药卫生—治疗学]