自体动静脉内瘘多次外科手术高危因素分析  

Analysis of high-risk factors for multiple surgical operations for autogenous arteriovenous fistula

作　　者：袁红波[1] 陈晓霞[1] 端颖 张洋 周玥[1] Yuan Hongbo;Chen Xiaoxia;Duan Ying;Zhang Yang;Zhou Yue(Department of Nephrology Center,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,Jiangsu,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)肾脏科,江苏南京210006

出　　处：《血管与腔内血管外科杂志》2023年第11期1323-1326,共4页Journal of Vascular and Endovascular Surgery

基　　金：国家自然青年科学基金项目(82000693);南京市卫生科技发展专项基金项目(GBX21304)。

摘　　要：目的 探讨自体动静脉内瘘(AVF)多次外科手术危险因素。方法 收集2020年1月至2022年5月南京医科大学附属南京医院(南京市第一医院)就诊的183例维持性血液透析患者的临床资料,根据手术次数的不同将其分为单次手术组(n=93)和多次(手术次数≥2次)手术组(n=90),记录两组患者的一般资料、既往史、透析资料、药物使用情况、血常规、生化指标,分析AVF多次外科手术的危险因素。结果 多次手术组患者血液透析维持时间、中心静脉置管(CVC)、尿素清除率(URR)、血清钙水平均高于单次手术组患者,(P﹤0.05)。多因素分析结果显示,CVC、血液透析维持时间、血清钙均是AVF多次手术的独立危险因素(P﹤0.05)。结论 CVC、血液透析维持时间、血清钙均是AVF多次手术的独立危险因素,慢性肾脏病患者应在发展至终末期肾脏病(ESRD)前尽快行AVF成形术,建立长期透析通路,提高在透析开始时AVF通路的使用率,降低临时股静脉或颈内静脉等CVC使用率,从而为AVF相关并发症提供预防及治疗措施。Objective To investigate the high-risk factors of multiple surgical operations for autologous arteriovenous fistula.Method The clinical data of 183 maintenance hemodialysis patients treated at Nanjing First Hospital,Nanjing Medical University from January 2010 to May 2022 were collected.They were divided into single surgery group(n=93)and multiple surgery group(n=90,number of surgeries≥2 times)according to the number of surgeries.The general data,history,dialysis data,drug use,blood routine,biochemical indicators,of the two groups of patients were recorded,the risk factors for multiple AVF surgeries were analyzed.Result The hemodialysis maintenance time,central venous catheter(CVC),urea clearance rate(URR),and serum calcium level of patients in the multiple surgery group were all longer than those in the single surgery group(P<0.05).Multivariate analysis results showed that CVC,hemodialysis maintenance time,and serum calcium were independent risk factors for multipleAVF surgeries(P<0.05).Conclusion CVC,maintenance time of hemodialysis,and serum calcium are all independent risk factors for multiple AVF surgeries.For patients with chronic kidney disease,AVF reconstruction surgery should be performed as soon as possible before the progression to end-stage renal disease(ESRD),establishing a long-term dialysis pathway,increasing the use of AVF pathway at the beginning of dialysis,reducing the use of temporary femoral vein or internal jugular vein CVC,and providing prevention and treatment measures forAVF related complications.

关 键 词：自体动静脉内瘘 血液透析 中心静脉置管 

分 类 号：R543[医药卫生—心血管疾病]