医联体分级共管模式对血液透析患者移植物内瘘通畅的影响  

Effects of hierarchical management based on medical alliances on patency of arteriovenous graft in hemodialysis patients

作　　者：岳晓红[1] 梁献慧[1] 刘亚敏 王欣芳[1] 王瑞敏[1] 薛小玲 王沛[1] 袁媛[2] Yue Xiaohong;Liang Xianhui;Liu Yamin;Wang Xinfang;Wang Ruimin;Xue Xiaoling;Wang Pei;Yuan Yuan(Blood Purification Center,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Internal Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院血液净化中心,郑州450052 [2]郑州大学第一附属医院内科医学部,郑州450052

出　　处：《中华肾脏病杂志》2023年第6期438-445,共8页Chinese Journal of Nephrology

基　　金：郑州大学第一附属医院青年基金(70300)。

摘　　要：目的探讨医联体分级共管模式对移植物内瘘(arteriovenous graft,AVG)通畅率的影响,为进一步优化AVG管理提供依据。方法该研究为回顾性队列研究,分析郑州大学第一附属医院2018年1月1日至2021年12月31日建立AVG患者的临床及随访资料,根据是否加入分级共管模式分为医联体组和非医联体组,比较两组AVG通畅率及临床事件发生率。结果该研究共纳入328例次AVG,来自151个血液透析中心,其中医联体组189例次(57.6%),来自72个中心,非医联体组139例次(42.4%),来自79个中心。患者年龄(55.57±11.80)岁,男性130例次(39.6%),合并糖尿病126例次(38.4%)。该队列AVG随访15.5(9.5,26.2)个月,其中医联体组随访15.4(9.8,25.2)个月,非医联体组随访15.5(9.2,27.3)个月。医联体组通路血栓/闭塞的发生率(0.328次/患者年)、移植物夹层发生率(0.007次/患者年)、移植物感染发生率(0.030次/患者年)及导管使用率(0.043次/患者年)均低于非医联体组(0.589次/患者年、0.040次/患者年、0.054次/患者年、0.147次/患者年),而两组的诊室随访率相差不大,分别为1.91次/患者年和1.94次/患者年。医联体组中位一期通畅时间为17.4(95%CI 11.3~23.5)个月,中位一期辅助通畅时间为32.6(95%CI 25.0~40.2)个月,中位二期通畅时间为47.9(95%CI 40.0~55.8)个月,而非医联体组分别为12.3(95%CI 9.4~15.2)个月、19.4(95%CI 14.3~24.5)个月和34.6(95%CI 29.3~39.9)个月。医联体组6、12、24、36个月的一期通畅率分别为77.4%、62.2%、39.9%和26.6%,显著高于非医联体组(71.1%、50.1%、30.6%和13.4%)(Log-rank检验,χ2=4.504,P=0.034)。医联体组6、12、24、36个月的一期辅助通畅率分别为90.9%、84.3%、67.1%和46.1%,亦显著高于非医联体组(89.2%、75.7%、42.0%和16.6%)(Log-rank检验,χ2=10.655,P=0.001)。医联体组6、12、24、36个月的二期通畅率分别为96.8%、91.8%、84.2%和74.0%,同样显著高于非医联体组(89.9%、85.8%、69.3%和47.5%)(Log-rank检�Objective To investigate the impacts of hierarchical management based on medical alliance on the patency of arteriovenous graft(AVG),and provide a basis for further exploration of optimal AVG management.Methods In this retrospective cohort study,clinical and follow-up data of patients with AVG established in the First Affiliated Hospital of Zhengzhou University from January 1,2018 to December 31,2021 were analyzed.Patients were divided into medical alliance group and non-medical alliance group according to whether they were under hierarchical management model,and the patency rate of AVGs and the incidence of clinical events were compared between the two groups.Results A total of 328 AVGs were included in this study,which were from 151 hemodialysis centers,including 189 AVGs(57.6%)from 72 centers in medical alliance group,and 139 AVGs(42.4%)from 79 centers in non-medical alliance group.The age of the patients was(55.57±11.80)years,among whom 130(39.6%)were males and 126(38.4%)were diabetic.The follow-up time of AVGs in this cohort was 15.5(9.5,26.2)months,with 15.4(9.8,25.2)months in medical alliance group and 15.5(9.2,27.3)months in non-medical alliance group.The incidence of thrombosis or occlusion(0.328 times/patient-year),graft dissection(0.007 times/patient-year),graft infection(0.030 times/patient-year),and catheter utilization(0.043 times/patient-year)in the medical alliance group were lower than those in the non-medical alliance group(0.589 times/patient-year,0.040 times/patient-year,0.054 times/patient-year and 0.147 times/patient-year,respectively),and there was no significant difference in clinic follow-up rates between the two group(1.91 times/patient-year vs.1.94 times/patient-year).The median primary patency time was 17.4(95%CI 11.3-23.5)months,the median primary assisted patency time was 32.6(95%CI 25.0-40.2)months,and the median secondary patency time was 47.9(95%CI 40.0-55.8)months in the medical alliance group,compared with 12.3(95%CI 9.4-15.2)months,19.4(95%CI 14.3-24.5)months,and 34.6(95%CI 29

关 键 词：手术后并发症 移植物闭塞 血管 疾病管理 移植物内瘘 医联体 通畅率 临床事件 

分 类 号：R459.5[医药卫生—治疗学]